|
CB MRI UE JNT W/O
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
2100066
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$199.09 |
| Max. Negotiated Rate |
$3,800.00 |
| 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 |
$2,400.00
|
| 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 |
$2,400.00
|
| 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 |
$3,200.00
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,600.00
|
| 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 |
$3,640.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,800.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,600.00
|
| 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 |
$3,800.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$3,000.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$3,400.00
|
| 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 |
$3,720.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$1,600.00
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$407.01
|
|
|
CB MRI UE JNT W/WO
|
Facility
|
IP
|
$5,293.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
2100023
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$609.55 |
| Max. Negotiated Rate |
$5,028.35 |
| Rate for Payer: Cash Price |
$3,175.80
|
| Rate for Payer: Cash Price |
$3,175.80
|
| Rate for Payer: Cigna Commercial |
$4,499.05
|
| Rate for Payer: First Health Commercial |
$4,763.70
|
| Rate for Payer: First Health Workers Compensation |
$862.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,763.70
|
| Rate for Payer: GEHA Commercial |
$3,705.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,763.70
|
| Rate for Payer: Multiplan All |
$4,816.63
|
| Rate for Payer: OMNI Networks Commercial |
$3,705.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,763.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,028.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,969.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,922.49
|
| Rate for Payer: Zelis Auto |
$2,117.20
|
| Rate for Payer: Zelis Worker's Compensation |
$609.55
|
|
|
CB MRI UE JNT W/WO
|
Facility
|
OP
|
$5,293.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
2100023
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$5,028.35 |
| 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 |
$3,175.80
|
| 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 |
$3,175.80
|
| Rate for Payer: Cash Price |
$3,175.80
|
| Rate for Payer: Cigna Commercial |
$4,499.05
|
| Rate for Payer: First Health Commercial |
$4,763.70
|
| Rate for Payer: First Health Workers Compensation |
$862.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,763.70
|
| Rate for Payer: GEHA Commercial |
$4,234.40
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,763.70
|
| 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 |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$346.05
|
| Rate for Payer: Multiplan All |
$4,816.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,705.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,763.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,028.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,969.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$4,499.05
|
| 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 |
$4,922.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$2,117.20
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$609.55
|
|
|
CB MRI UE NON-JNT W/CON
|
Facility
|
IP
|
$3,801.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
2100088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$461.38 |
| Max. Negotiated Rate |
$3,610.95 |
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$3,230.85
|
| Rate for Payer: First Health Commercial |
$3,420.90
|
| Rate for Payer: First Health Workers Compensation |
$652.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,420.90
|
| Rate for Payer: GEHA Commercial |
$2,660.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,420.90
|
| Rate for Payer: Multiplan All |
$3,458.91
|
| Rate for Payer: OMNI Networks Commercial |
$2,660.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,420.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,610.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,850.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,534.93
|
| Rate for Payer: Zelis Auto |
$1,520.40
|
| Rate for Payer: Zelis Worker's Compensation |
$461.38
|
|
|
CB MRI UE NON-JNT W/CON
|
Facility
|
OP
|
$3,801.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
2100088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$3,610.95 |
| 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 |
$2,280.60
|
| 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 |
$346.05
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$3,230.85
|
| Rate for Payer: First Health Commercial |
$3,420.90
|
| Rate for Payer: First Health Workers Compensation |
$652.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,420.90
|
| Rate for Payer: GEHA Commercial |
$3,040.80
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,420.90
|
| 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 |
$3,458.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$2,660.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,420.90
|
| 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 |
$3,610.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,850.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$3,230.85
|
| 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 |
$3,534.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$1,520.40
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$461.38
|
|
|
CB MRI UE NON-JNT W/O
|
Facility
|
IP
|
$3,857.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
2100019
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$405.98 |
| Max. Negotiated Rate |
$3,664.15 |
| Rate for Payer: Cash Price |
$2,314.20
|
| Rate for Payer: Cash Price |
$2,314.20
|
| Rate for Payer: Cigna Commercial |
$3,278.45
|
| Rate for Payer: First Health Commercial |
$3,471.30
|
| Rate for Payer: First Health Workers Compensation |
$574.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,471.30
|
| Rate for Payer: GEHA Commercial |
$2,699.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,471.30
|
| Rate for Payer: Multiplan All |
$3,509.87
|
| Rate for Payer: OMNI Networks Commercial |
$2,699.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,471.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,664.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,892.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,587.01
|
| Rate for Payer: Zelis Auto |
$1,542.80
|
| Rate for Payer: Zelis Worker's Compensation |
$405.98
|
|
|
CB MRI UE NON-JNT W/O
|
Facility
|
OP
|
$3,857.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
2100019
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$199.09 |
| Max. Negotiated Rate |
$3,664.15 |
| 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 |
$2,314.20
|
| 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 |
$2,314.20
|
| Rate for Payer: Cash Price |
$2,314.20
|
| Rate for Payer: Cigna Commercial |
$3,278.45
|
| Rate for Payer: First Health Commercial |
$3,471.30
|
| Rate for Payer: First Health Workers Compensation |
$574.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,471.30
|
| Rate for Payer: GEHA Commercial |
$3,085.60
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,471.30
|
| 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 |
$3,509.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,699.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,471.30
|
| 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 |
$3,664.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$2,892.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$3,278.45
|
| 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 |
$3,587.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$1,542.80
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$405.98
|
|
|
CB MRI UE NON-JNT W/WO
|
Facility
|
OP
|
$5,040.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
2100060
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,024.00
|
| 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 |
$346.05
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cigna Commercial |
$4,284.00
|
| Rate for Payer: First Health Commercial |
$4,536.00
|
| Rate for Payer: First Health Workers Compensation |
$791.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,536.00
|
| Rate for Payer: GEHA Commercial |
$4,032.00
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,536.00
|
| 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 |
$4,586.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,528.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,536.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,788.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,780.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$4,284.00
|
| 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 |
$4,687.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$2,016.00
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$559.98
|
|
|
CB MRI UE NON-JNT W/WO
|
Facility
|
OP
|
$5,040.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
2100093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,024.00
|
| 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 |
$346.05
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cigna Commercial |
$4,284.00
|
| Rate for Payer: First Health Commercial |
$4,536.00
|
| Rate for Payer: First Health Workers Compensation |
$791.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,536.00
|
| Rate for Payer: GEHA Commercial |
$4,032.00
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,536.00
|
| 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 |
$4,586.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,528.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,536.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,788.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,780.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$4,284.00
|
| 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 |
$4,687.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$2,016.00
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$559.98
|
|
|
CB MRI UE NON-JNT W/WO
|
Facility
|
IP
|
$5,040.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
2100060
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$559.98 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cigna Commercial |
$4,284.00
|
| Rate for Payer: First Health Commercial |
$4,536.00
|
| Rate for Payer: First Health Workers Compensation |
$791.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,536.00
|
| Rate for Payer: GEHA Commercial |
$3,528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,536.00
|
| Rate for Payer: Multiplan All |
$4,586.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,528.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,536.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,788.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,780.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,687.20
|
| Rate for Payer: Zelis Auto |
$2,016.00
|
| Rate for Payer: Zelis Worker's Compensation |
$559.98
|
|
|
CB MRI UE NON-JNT W/WO
|
Facility
|
IP
|
$5,040.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
2100093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$559.98 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cigna Commercial |
$4,284.00
|
| Rate for Payer: First Health Commercial |
$4,536.00
|
| Rate for Payer: First Health Workers Compensation |
$791.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,536.00
|
| Rate for Payer: GEHA Commercial |
$3,528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,536.00
|
| Rate for Payer: Multiplan All |
$4,586.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,528.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,536.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,788.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,780.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,687.20
|
| Rate for Payer: Zelis Auto |
$2,016.00
|
| Rate for Payer: Zelis Worker's Compensation |
$559.98
|
|
|
CB MYELOGRAPHY CERVICAL RS&I
|
Facility
|
OP
|
$2,610.00
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
2900092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.88 |
| Max. Negotiated Rate |
$2,479.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$730.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,566.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$730.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$578.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$765.55
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cigna Commercial |
$2,218.50
|
| Rate for Payer: First Health Commercial |
$2,349.00
|
| Rate for Payer: First Health Workers Compensation |
$169.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,349.00
|
| Rate for Payer: GEHA Commercial |
$2,088.00
|
| Rate for Payer: GEHA Medicare |
$765.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,349.00
|
| 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 |
$590.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$765.55
|
| Rate for Payer: Multiplan All |
$2,375.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,301.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,827.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,349.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$681.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$590.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$765.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,479.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,531.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,957.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$750.24
|
| Rate for Payer: United Healthcare Commercial |
$2,218.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$590.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$765.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,427.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$765.55
|
| Rate for Payer: Zelis Auto |
$1,044.00
|
| Rate for Payer: Zelis Medicare |
$650.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$918.66
|
| Rate for Payer: Zelis Worker's Compensation |
$119.88
|
|
|
CB MYELOGRAPHY CERVICAL RS&I
|
Facility
|
IP
|
$2,610.00
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
2900092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.88 |
| Max. Negotiated Rate |
$2,479.50 |
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cigna Commercial |
$2,218.50
|
| Rate for Payer: First Health Commercial |
$2,349.00
|
| Rate for Payer: First Health Workers Compensation |
$169.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,349.00
|
| Rate for Payer: GEHA Commercial |
$1,827.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,349.00
|
| Rate for Payer: Multiplan All |
$2,375.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,827.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,349.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,479.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,957.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,427.30
|
| Rate for Payer: Zelis Auto |
$1,044.00
|
| Rate for Payer: Zelis Worker's Compensation |
$119.88
|
|
|
CB MYELOGRAPHY THORACIC RS&I
|
Facility
|
OP
|
$2,288.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
2900094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.14 |
| Max. Negotiated Rate |
$2,173.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$730.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,372.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$730.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$578.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$765.55
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cigna Commercial |
$1,944.80
|
| Rate for Payer: First Health Commercial |
$2,059.20
|
| Rate for Payer: First Health Workers Compensation |
$160.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,059.20
|
| Rate for Payer: GEHA Commercial |
$1,830.40
|
| Rate for Payer: GEHA Medicare |
$765.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,059.20
|
| 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 |
$590.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$765.55
|
| Rate for Payer: Multiplan All |
$2,082.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,301.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,601.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,059.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$681.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$590.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$765.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,173.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,531.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,716.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$750.24
|
| Rate for Payer: United Healthcare Commercial |
$1,944.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$590.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$765.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,127.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$765.55
|
| Rate for Payer: Zelis Auto |
$915.20
|
| Rate for Payer: Zelis Medicare |
$650.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$918.66
|
| Rate for Payer: Zelis Worker's Compensation |
$113.14
|
|
|
CB MYELOGRAPHY THORACIC RS&I
|
Facility
|
IP
|
$2,288.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
2900094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.14 |
| Max. Negotiated Rate |
$2,173.60 |
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cigna Commercial |
$1,944.80
|
| Rate for Payer: First Health Commercial |
$2,059.20
|
| Rate for Payer: First Health Workers Compensation |
$160.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,059.20
|
| Rate for Payer: GEHA Commercial |
$1,601.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,059.20
|
| Rate for Payer: Multiplan All |
$2,082.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,601.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,059.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,173.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,716.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,127.84
|
| Rate for Payer: Zelis Auto |
$915.20
|
| Rate for Payer: Zelis Worker's Compensation |
$113.14
|
|
|
CB MYELOGRAPY 2/MORE REGIONS RS&I
|
Facility
|
OP
|
$3,479.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
2900091
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.66 |
| Max. Negotiated Rate |
$3,305.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$730.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,087.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$730.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$578.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$765.55
|
| Rate for Payer: Cash Price |
$2,087.40
|
| Rate for Payer: Cash Price |
$2,087.40
|
| Rate for Payer: Cigna Commercial |
$2,957.15
|
| Rate for Payer: First Health Commercial |
$3,131.10
|
| Rate for Payer: First Health Workers Compensation |
$241.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,131.10
|
| Rate for Payer: GEHA Commercial |
$2,783.20
|
| Rate for Payer: GEHA Medicare |
$765.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,131.10
|
| 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 |
$590.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$765.55
|
| Rate for Payer: Multiplan All |
$3,165.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,301.43
|
| Rate for Payer: OMNI Networks Commercial |
$2,435.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,131.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$681.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$590.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$765.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,305.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,531.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,609.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$750.24
|
| Rate for Payer: United Healthcare Commercial |
$2,957.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$590.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$765.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,235.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$765.55
|
| Rate for Payer: Zelis Auto |
$1,391.60
|
| Rate for Payer: Zelis Medicare |
$650.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$918.66
|
| Rate for Payer: Zelis Worker's Compensation |
$170.66
|
|
|
CB MYELOGRAPY 2/MORE REGIONS RS&I
|
Facility
|
IP
|
$3,479.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
2900091
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.66 |
| Max. Negotiated Rate |
$3,305.05 |
| Rate for Payer: Cash Price |
$2,087.40
|
| Rate for Payer: Cash Price |
$2,087.40
|
| Rate for Payer: Cigna Commercial |
$2,957.15
|
| Rate for Payer: First Health Commercial |
$3,131.10
|
| Rate for Payer: First Health Workers Compensation |
$241.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,131.10
|
| Rate for Payer: GEHA Commercial |
$2,435.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,131.10
|
| Rate for Payer: Multiplan All |
$3,165.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,435.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,131.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,305.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,609.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,235.47
|
| Rate for Payer: Zelis Auto |
$1,391.60
|
| Rate for Payer: Zelis Worker's Compensation |
$170.66
|
|
|
CB MYELOGRAPY LUMBOSACRAL RS&I
|
Facility
|
IP
|
$2,425.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
2900093
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.74 |
| Max. Negotiated Rate |
$2,303.75 |
| Rate for Payer: Cash Price |
$1,455.00
|
| Rate for Payer: Cash Price |
$1,455.00
|
| Rate for Payer: Cigna Commercial |
$2,061.25
|
| Rate for Payer: First Health Commercial |
$2,182.50
|
| Rate for Payer: First Health Workers Compensation |
$141.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,182.50
|
| Rate for Payer: GEHA Commercial |
$1,697.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,182.50
|
| Rate for Payer: Multiplan All |
$2,206.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,697.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,182.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,303.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,818.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,255.25
|
| Rate for Payer: Zelis Auto |
$970.00
|
| Rate for Payer: Zelis Worker's Compensation |
$99.74
|
|
|
CB MYELOGRAPY LUMBOSACRAL RS&I
|
Facility
|
OP
|
$2,425.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
2900093
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.74 |
| Max. Negotiated Rate |
$2,303.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$730.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,455.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$730.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$578.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$765.55
|
| Rate for Payer: Cash Price |
$1,455.00
|
| Rate for Payer: Cash Price |
$1,455.00
|
| Rate for Payer: Cigna Commercial |
$2,061.25
|
| Rate for Payer: First Health Commercial |
$2,182.50
|
| Rate for Payer: First Health Workers Compensation |
$141.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,182.50
|
| Rate for Payer: GEHA Commercial |
$1,940.00
|
| Rate for Payer: GEHA Medicare |
$765.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,182.50
|
| 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 |
$590.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$765.55
|
| Rate for Payer: Multiplan All |
$2,206.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,301.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,697.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,182.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$681.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$590.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$765.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,303.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,531.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,818.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$750.24
|
| Rate for Payer: United Healthcare Commercial |
$2,061.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$590.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$765.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,255.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$765.55
|
| Rate for Payer: Zelis Auto |
$970.00
|
| Rate for Payer: Zelis Medicare |
$650.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$918.66
|
| Rate for Payer: Zelis Worker's Compensation |
$99.74
|
|
|
CB RADEX COLON BARIUM ENEMA W/WO KUB
|
Facility
|
OP
|
$1,188.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
2900023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$1,128.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$712.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$104.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$172.50
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cigna Commercial |
$1,009.80
|
| Rate for Payer: First Health Commercial |
$1,069.20
|
| Rate for Payer: First Health Workers Compensation |
$189.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,069.20
|
| Rate for Payer: GEHA Commercial |
$950.40
|
| Rate for Payer: GEHA Medicare |
$172.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,069.20
|
| Rate for Payer: Humana ChoiceCare |
$189.75
|
| Rate for Payer: Humana Medicare Advantage |
$172.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$289.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$106.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$172.50
|
| Rate for Payer: Multiplan All |
$1,081.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$293.25
|
| Rate for Payer: OMNI Networks Commercial |
$831.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,069.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$122.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$106.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$172.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,128.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$345.00
|
| Rate for Payer: Three Rivers Provider Network All |
$891.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.05
|
| Rate for Payer: United Healthcare Commercial |
$1,009.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,104.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$172.50
|
| Rate for Payer: Zelis Auto |
$475.20
|
| Rate for Payer: Zelis Medicare |
$146.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$207.00
|
| Rate for Payer: Zelis Worker's Compensation |
$133.64
|
|
|
CB RADEX COLON BARIUM ENEMA W/WO KUB
|
Facility
|
IP
|
$1,188.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
2900023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.64 |
| Max. Negotiated Rate |
$1,128.60 |
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cigna Commercial |
$1,009.80
|
| Rate for Payer: First Health Commercial |
$1,069.20
|
| Rate for Payer: First Health Workers Compensation |
$189.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,069.20
|
| Rate for Payer: GEHA Commercial |
$831.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,069.20
|
| Rate for Payer: Multiplan All |
$1,081.08
|
| Rate for Payer: OMNI Networks Commercial |
$831.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,069.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,128.60
|
| Rate for Payer: Three Rivers Provider Network All |
$891.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,104.84
|
| Rate for Payer: Zelis Auto |
$475.20
|
| Rate for Payer: Zelis Worker's Compensation |
$133.64
|
|
|
CB RADEX COLON W/SPEC HI DNS BARIUM W/WO
|
Facility
|
OP
|
$1,528.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
2900025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.62 |
| Max. Negotiated Rate |
$1,451.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$212.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$916.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$212.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$168.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$172.50
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cigna Commercial |
$1,298.80
|
| Rate for Payer: First Health Commercial |
$1,375.20
|
| Rate for Payer: First Health Workers Compensation |
$273.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,375.20
|
| Rate for Payer: GEHA Commercial |
$1,222.40
|
| Rate for Payer: GEHA Medicare |
$172.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,375.20
|
| Rate for Payer: Humana ChoiceCare |
$189.75
|
| Rate for Payer: Humana Medicare Advantage |
$172.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$289.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$171.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$172.50
|
| Rate for Payer: Multiplan All |
$1,390.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$293.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,069.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,375.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$198.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$171.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$172.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,451.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$345.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,146.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$169.05
|
| Rate for Payer: United Healthcare Commercial |
$1,298.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,421.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$172.50
|
| Rate for Payer: Zelis Auto |
$611.20
|
| Rate for Payer: Zelis Medicare |
$146.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$207.00
|
| Rate for Payer: Zelis Worker's Compensation |
$193.05
|
|
|
CB RADEX COLON W/SPEC HI DNS BARIUM W/WO
|
Facility
|
IP
|
$1,528.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
2900025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.05 |
| Max. Negotiated Rate |
$1,451.60 |
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cigna Commercial |
$1,298.80
|
| Rate for Payer: First Health Commercial |
$1,375.20
|
| Rate for Payer: First Health Workers Compensation |
$273.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,375.20
|
| Rate for Payer: GEHA Commercial |
$1,069.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,375.20
|
| Rate for Payer: Multiplan All |
$1,390.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,069.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,375.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,451.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,146.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,421.04
|
| Rate for Payer: Zelis Auto |
$611.20
|
| Rate for Payer: Zelis Worker's Compensation |
$193.05
|
|
|
CB RADEX ENTIR THRC LMBR CRV SAC SPI W/S
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
2900115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.81 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: First Health Workers Compensation |
$119.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.81
|
|
|
CB RADEX ENTIR THRC LMBR CRV SAC SPI W/S
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
2900113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.81 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$228.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$103.04
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: First Health Workers Compensation |
$97.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$232.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$268.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$232.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$561.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$232.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$68.81
|
|
