|
CB MRI MRCP (MRI ABD W/O)
|
Facility
|
OP
|
$4,100.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
2174181
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$199.09 |
| 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 |
$234.22
|
| 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 |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,690.00
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$3,731.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| 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 |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,895.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$3,075.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| 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 |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,813.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$1,640.00
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$393.06
|
|
|
CB MRI MRCP (MRI ABD W/O)
|
Facility
|
IP
|
$4,100.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
2174181
|
|
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 ORB/FAC/NEC W/O
|
Facility
|
OP
|
$4,022.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
2100026
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$199.09 |
| Max. Negotiated Rate |
$3,820.90 |
| 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 |
$2,413.20
|
| 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 |
$234.22
|
| Rate for Payer: Cash Price |
$2,413.20
|
| Rate for Payer: Cash Price |
$2,413.20
|
| Rate for Payer: Cigna Commercial |
$3,418.70
|
| Rate for Payer: First Health Commercial |
$3,619.80
|
| Rate for Payer: First Health Workers Compensation |
$575.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,619.80
|
| Rate for Payer: GEHA Commercial |
$3,217.60
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,619.80
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$3,660.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,815.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,619.80
|
| 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 |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,820.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$3,016.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$3,418.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,740.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$1,608.80
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$406.82
|
|
|
CB MRI ORB/FAC/NEC W/O
|
Facility
|
IP
|
$4,022.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
2100026
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$406.82 |
| Max. Negotiated Rate |
$3,820.90 |
| Rate for Payer: Cash Price |
$2,413.20
|
| Rate for Payer: Cash Price |
$2,413.20
|
| Rate for Payer: Cigna Commercial |
$3,418.70
|
| Rate for Payer: First Health Commercial |
$3,619.80
|
| Rate for Payer: First Health Workers Compensation |
$575.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,619.80
|
| Rate for Payer: GEHA Commercial |
$2,815.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,619.80
|
| Rate for Payer: Multiplan All |
$3,660.02
|
| Rate for Payer: OMNI Networks Commercial |
$2,815.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,619.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,820.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,016.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,740.46
|
| Rate for Payer: Zelis Auto |
$1,608.80
|
| Rate for Payer: Zelis Worker's Compensation |
$406.82
|
|
|
CB MRI ORB/FAC/NEC W/WO
|
Facility
|
IP
|
$5,508.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
2100027
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$620.63 |
| Max. Negotiated Rate |
$5,232.60 |
| Rate for Payer: Cash Price |
$3,304.80
|
| Rate for Payer: Cash Price |
$3,304.80
|
| Rate for Payer: Cigna Commercial |
$4,681.80
|
| Rate for Payer: First Health Commercial |
$4,957.20
|
| Rate for Payer: First Health Workers Compensation |
$877.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,957.20
|
| Rate for Payer: GEHA Commercial |
$3,855.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,957.20
|
| Rate for Payer: Multiplan All |
$5,012.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,855.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,957.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,232.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,131.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,122.44
|
| Rate for Payer: Zelis Auto |
$2,203.20
|
| Rate for Payer: Zelis Worker's Compensation |
$620.63
|
|
|
CB MRI ORB/FAC/NEC W/WO
|
Facility
|
OP
|
$5,508.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
2100027
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$5,232.60 |
| 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 |
$3,304.80
|
| 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 |
$346.05
|
| Rate for Payer: Cash Price |
$3,304.80
|
| Rate for Payer: Cash Price |
$3,304.80
|
| Rate for Payer: Cigna Commercial |
$4,681.80
|
| Rate for Payer: First Health Commercial |
$4,957.20
|
| Rate for Payer: First Health Workers Compensation |
$877.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,957.20
|
| Rate for Payer: GEHA Commercial |
$4,406.40
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,957.20
|
| Rate for Payer: Humana ChoiceCare |
$380.65
|
| Rate for Payer: Humana Medicare Advantage |
$346.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$581.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$346.05
|
| Rate for Payer: Multiplan All |
$5,012.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,855.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,957.20
|
| 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 |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,232.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,131.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$4,681.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,122.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$2,203.20
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$620.63
|
|
|
CB MRI PELVIS W/CON
|
Facility
|
OP
|
$4,533.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
2100087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$4,306.35 |
| 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 |
$2,719.80
|
| 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 |
$346.05
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$3,853.05
|
| Rate for Payer: First Health Commercial |
$4,079.70
|
| Rate for Payer: First Health Workers Compensation |
$661.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,079.70
|
| Rate for Payer: GEHA Commercial |
$3,626.40
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,079.70
|
| Rate for Payer: Humana ChoiceCare |
$380.65
|
| Rate for Payer: Humana Medicare Advantage |
$346.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$581.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$346.05
|
| Rate for Payer: Multiplan All |
$4,125.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,173.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,079.70
|
| 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 |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,306.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,399.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$3,853.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,215.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$1,813.20
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$467.43
|
|
|
CB MRI PELVIS W/CON
|
Facility
|
IP
|
$4,533.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
2100087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$467.43 |
| Max. Negotiated Rate |
$4,306.35 |
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$3,853.05
|
| Rate for Payer: First Health Commercial |
$4,079.70
|
| Rate for Payer: First Health Workers Compensation |
$661.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,079.70
|
| Rate for Payer: GEHA Commercial |
$3,173.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,079.70
|
| Rate for Payer: Multiplan All |
$4,125.03
|
| Rate for Payer: OMNI Networks Commercial |
$3,173.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,079.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,306.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,399.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,215.69
|
| Rate for Payer: Zelis Auto |
$1,813.20
|
| Rate for Payer: Zelis Worker's Compensation |
$467.43
|
|
|
CB MRI PELVIS W/O
|
Facility
|
OP
|
$3,910.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
2100028
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$199.09 |
| Max. Negotiated Rate |
$3,714.50 |
| 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 |
$2,346.00
|
| 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 |
$234.22
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cigna Commercial |
$3,323.50
|
| Rate for Payer: First Health Commercial |
$3,519.00
|
| Rate for Payer: First Health Workers Compensation |
$575.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,519.00
|
| Rate for Payer: GEHA Commercial |
$3,128.00
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,519.00
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$3,558.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,737.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,519.00
|
| 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 |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,714.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$2,932.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$3,323.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,636.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$1,564.00
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$406.97
|
|
|
CB MRI PELVIS W/O
|
Facility
|
IP
|
$3,910.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
2100028
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$406.97 |
| Max. Negotiated Rate |
$3,714.50 |
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cigna Commercial |
$3,323.50
|
| Rate for Payer: First Health Commercial |
$3,519.00
|
| Rate for Payer: First Health Workers Compensation |
$575.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,519.00
|
| Rate for Payer: GEHA Commercial |
$2,737.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,519.00
|
| Rate for Payer: Multiplan All |
$3,558.10
|
| Rate for Payer: OMNI Networks Commercial |
$2,737.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,519.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,714.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,932.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,636.30
|
| Rate for Payer: Zelis Auto |
$1,564.00
|
| Rate for Payer: Zelis Worker's Compensation |
$406.97
|
|
|
CB MRI PELVIS W/WO
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
2400131
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$5,175.60 |
| 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 |
$3,268.80
|
| 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 |
$346.05
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cigna Commercial |
$4,630.80
|
| Rate for Payer: First Health Commercial |
$4,903.20
|
| Rate for Payer: First Health Workers Compensation |
$877.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,903.20
|
| Rate for Payer: GEHA Commercial |
$4,358.40
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,903.20
|
| Rate for Payer: Humana ChoiceCare |
$380.65
|
| Rate for Payer: Humana Medicare Advantage |
$346.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$581.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$346.05
|
| Rate for Payer: Multiplan All |
$4,957.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,813.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,903.20
|
| 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 |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,175.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,086.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$4,630.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,066.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$2,179.20
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$620.58
|
|
|
CB MRI PELVIS W/WO
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
2400131
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$620.58 |
| Max. Negotiated Rate |
$5,175.60 |
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cigna Commercial |
$4,630.80
|
| Rate for Payer: First Health Commercial |
$4,903.20
|
| Rate for Payer: First Health Workers Compensation |
$877.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,903.20
|
| Rate for Payer: GEHA Commercial |
$3,813.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,903.20
|
| Rate for Payer: Multiplan All |
$4,957.68
|
| Rate for Payer: OMNI Networks Commercial |
$3,813.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,903.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,175.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,086.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,066.64
|
| Rate for Payer: Zelis Auto |
$2,179.20
|
| Rate for Payer: Zelis Worker's Compensation |
$620.58
|
|
|
CB MRI SCROTUM W/WO
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
2100025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$5,175.60 |
| 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 |
$3,268.80
|
| 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 |
$346.05
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cigna Commercial |
$4,630.80
|
| Rate for Payer: First Health Commercial |
$4,903.20
|
| Rate for Payer: First Health Workers Compensation |
$877.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,903.20
|
| Rate for Payer: GEHA Commercial |
$4,358.40
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,903.20
|
| Rate for Payer: Humana ChoiceCare |
$380.65
|
| Rate for Payer: Humana Medicare Advantage |
$346.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$581.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$346.05
|
| Rate for Payer: Multiplan All |
$4,957.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,813.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,903.20
|
| 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 |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,175.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,086.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$4,630.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,066.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$2,179.20
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$620.58
|
|
|
CB MRI SCROTUM W/WO
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
2100025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$620.58 |
| Max. Negotiated Rate |
$5,175.60 |
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cigna Commercial |
$4,630.80
|
| Rate for Payer: First Health Commercial |
$4,903.20
|
| Rate for Payer: First Health Workers Compensation |
$877.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,903.20
|
| Rate for Payer: GEHA Commercial |
$3,813.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,903.20
|
| Rate for Payer: Multiplan All |
$4,957.68
|
| Rate for Payer: OMNI Networks Commercial |
$3,813.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,903.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,175.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,086.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,066.64
|
| Rate for Payer: Zelis Auto |
$2,179.20
|
| Rate for Payer: Zelis Worker's Compensation |
$620.58
|
|
|
CB MRI TMJ
|
Facility
|
OP
|
$3,596.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
2100036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$199.09 |
| Max. Negotiated Rate |
$3,416.20 |
| 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 |
$2,157.60
|
| 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 |
$234.22
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cigna Commercial |
$3,056.60
|
| Rate for Payer: First Health Commercial |
$3,236.40
|
| Rate for Payer: First Health Workers Compensation |
$552.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,236.40
|
| Rate for Payer: GEHA Commercial |
$2,876.80
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,236.40
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$3,272.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,517.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,236.40
|
| 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 |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,416.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$2,697.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$3,056.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,344.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$1,438.40
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$390.43
|
|
|
CB MRI TMJ
|
Facility
|
IP
|
$3,596.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
2100036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$390.43 |
| Max. Negotiated Rate |
$3,416.20 |
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cigna Commercial |
$3,056.60
|
| Rate for Payer: First Health Commercial |
$3,236.40
|
| Rate for Payer: First Health Workers Compensation |
$552.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,236.40
|
| Rate for Payer: GEHA Commercial |
$2,517.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,236.40
|
| Rate for Payer: Multiplan All |
$3,272.36
|
| Rate for Payer: OMNI Networks Commercial |
$2,517.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,236.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,416.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,697.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,344.28
|
| Rate for Payer: Zelis Auto |
$1,438.40
|
| Rate for Payer: Zelis Worker's Compensation |
$390.43
|
|
|
CB MRI T-SPINE W/CON
|
Facility
|
OP
|
$4,548.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
2172147
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$4,320.60 |
| 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 |
$2,728.80
|
| 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 |
$346.05
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cigna Commercial |
$3,865.80
|
| Rate for Payer: First Health Commercial |
$4,093.20
|
| Rate for Payer: First Health Workers Compensation |
$661.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,093.20
|
| Rate for Payer: GEHA Commercial |
$3,638.40
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,093.20
|
| Rate for Payer: Humana ChoiceCare |
$380.65
|
| Rate for Payer: Humana Medicare Advantage |
$346.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$581.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$346.05
|
| Rate for Payer: Multiplan All |
$4,138.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,183.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,093.20
|
| 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 |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,320.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,411.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$3,865.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,229.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$1,819.20
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$467.80
|
|
|
CB MRI T-SPINE W/CON
|
Facility
|
IP
|
$4,548.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
2172147
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$467.80 |
| Max. Negotiated Rate |
$4,320.60 |
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cigna Commercial |
$3,865.80
|
| Rate for Payer: First Health Commercial |
$4,093.20
|
| Rate for Payer: First Health Workers Compensation |
$661.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,093.20
|
| Rate for Payer: GEHA Commercial |
$3,183.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,093.20
|
| Rate for Payer: Multiplan All |
$4,138.68
|
| Rate for Payer: OMNI Networks Commercial |
$3,183.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,093.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,320.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,411.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,229.64
|
| Rate for Payer: Zelis Auto |
$1,819.20
|
| Rate for Payer: Zelis Worker's Compensation |
$467.80
|
|
|
CB MRI T-SPINE W/O
|
Facility
|
OP
|
$4,105.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
2100034
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$199.09 |
| Max. Negotiated Rate |
$3,899.75 |
| 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 |
$2,463.00
|
| 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 |
$234.22
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cigna Commercial |
$3,489.25
|
| Rate for Payer: First Health Commercial |
$3,694.50
|
| Rate for Payer: First Health Workers Compensation |
$578.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,694.50
|
| Rate for Payer: GEHA Commercial |
$3,284.00
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,694.50
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$3,735.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,873.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,694.50
|
| 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 |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,899.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$3,078.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$3,489.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,817.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$1,642.00
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$408.74
|
|
|
CB MRI T-SPINE W/O
|
Facility
|
IP
|
$4,105.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
2100034
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$408.74 |
| Max. Negotiated Rate |
$3,899.75 |
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cigna Commercial |
$3,489.25
|
| Rate for Payer: First Health Commercial |
$3,694.50
|
| Rate for Payer: First Health Workers Compensation |
$578.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,694.50
|
| Rate for Payer: GEHA Commercial |
$2,873.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,694.50
|
| Rate for Payer: Multiplan All |
$3,735.55
|
| Rate for Payer: OMNI Networks Commercial |
$2,873.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,694.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,899.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,078.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,817.65
|
| Rate for Payer: Zelis Auto |
$1,642.00
|
| Rate for Payer: Zelis Worker's Compensation |
$408.74
|
|
|
CB MRI T-SPINE W/WO
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
2100035
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$570.51 |
| Max. Negotiated Rate |
$5,435.90 |
| Rate for Payer: Cash Price |
$3,433.20
|
| Rate for Payer: Cash Price |
$3,433.20
|
| Rate for Payer: Cigna Commercial |
$4,863.70
|
| Rate for Payer: First Health Commercial |
$5,149.80
|
| Rate for Payer: First Health Workers Compensation |
$806.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,149.80
|
| Rate for Payer: GEHA Commercial |
$4,005.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,149.80
|
| Rate for Payer: Multiplan All |
$5,207.02
|
| Rate for Payer: OMNI Networks Commercial |
$4,005.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,149.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,435.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,291.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,321.46
|
| Rate for Payer: Zelis Auto |
$2,288.80
|
| Rate for Payer: Zelis Worker's Compensation |
$570.51
|
|
|
CB MRI T-SPINE W/WO
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
2100035
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$5,435.90 |
| 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 |
$3,433.20
|
| 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 |
$346.05
|
| Rate for Payer: Cash Price |
$3,433.20
|
| Rate for Payer: Cash Price |
$3,433.20
|
| Rate for Payer: Cigna Commercial |
$4,863.70
|
| Rate for Payer: First Health Commercial |
$5,149.80
|
| Rate for Payer: First Health Workers Compensation |
$806.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,149.80
|
| Rate for Payer: GEHA Commercial |
$4,577.60
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,149.80
|
| Rate for Payer: Humana ChoiceCare |
$380.65
|
| Rate for Payer: Humana Medicare Advantage |
$346.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$581.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$346.05
|
| Rate for Payer: Multiplan All |
$5,207.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$4,005.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,149.80
|
| 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 |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,435.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,291.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$4,863.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,321.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$2,288.80
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$570.51
|
|
|
CB MRI UE JNT W/CON
|
Facility
|
OP
|
$4,277.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
2100092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$452.71 |
| Max. Negotiated Rate |
$4,063.15 |
| 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 |
$2,566.20
|
| 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 |
$765.55
|
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Cigna Commercial |
$3,635.45
|
| Rate for Payer: First Health Commercial |
$3,849.30
|
| Rate for Payer: First Health Workers Compensation |
$640.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,849.30
|
| Rate for Payer: GEHA Commercial |
$3,421.60
|
| Rate for Payer: GEHA Medicare |
$765.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,849.30
|
| Rate for Payer: Humana ChoiceCare |
$842.11
|
| Rate for Payer: Humana Medicare Advantage |
$765.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,286.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$765.55
|
| Rate for Payer: Multiplan All |
$3,892.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,301.43
|
| Rate for Payer: OMNI Networks Commercial |
$2,993.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,849.30
|
| 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 |
$765.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,063.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,531.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,207.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$750.24
|
| Rate for Payer: United Healthcare Commercial |
$3,635.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$765.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,977.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$765.55
|
| Rate for Payer: Zelis Auto |
$1,710.80
|
| Rate for Payer: Zelis Medicare |
$650.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$918.66
|
| Rate for Payer: Zelis Worker's Compensation |
$452.71
|
|
|
CB MRI UE JNT W/CON
|
Facility
|
IP
|
$4,277.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
2100092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$452.71 |
| Max. Negotiated Rate |
$4,063.15 |
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Cigna Commercial |
$3,635.45
|
| Rate for Payer: First Health Commercial |
$3,849.30
|
| Rate for Payer: First Health Workers Compensation |
$640.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,849.30
|
| Rate for Payer: GEHA Commercial |
$2,993.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,849.30
|
| Rate for Payer: Multiplan All |
$3,892.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,993.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,849.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,063.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,207.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,977.61
|
| Rate for Payer: Zelis Auto |
$1,710.80
|
| Rate for Payer: Zelis Worker's Compensation |
$452.71
|
|
|
CB MRI UE JNT W/O
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
2100066
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$407.01 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cigna Commercial |
$3,400.00
|
| Rate for Payer: First Health Commercial |
$3,600.00
|
| Rate for Payer: First Health Workers Compensation |
$575.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,600.00
|
| Rate for Payer: GEHA Commercial |
$2,800.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,600.00
|
| Rate for Payer: Multiplan All |
$3,640.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,800.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,600.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,800.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,000.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,720.00
|
| Rate for Payer: Zelis Auto |
$1,600.00
|
| Rate for Payer: Zelis Worker's Compensation |
$407.01
|
|
