|
MRA HEAD W/O
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
2000158
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,688.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,329.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cigna Commercial |
$3,300.55
|
| Rate for Payer: First Health Commercial |
$3,494.70
|
| Rate for Payer: First Health Workers Compensation |
$591.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,494.70
|
| Rate for Payer: GEHA Commercial |
$3,106.40
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,494.70
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,533.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,718.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,494.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,688.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,912.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,300.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,611.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,553.20
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$417.91
|
|
|
MRA HEAD W/O
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
2000158
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$417.91 |
| Max. Negotiated Rate |
$3,688.85 |
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cigna Commercial |
$3,300.55
|
| Rate for Payer: First Health Commercial |
$3,494.70
|
| Rate for Payer: First Health Workers Compensation |
$591.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,494.70
|
| Rate for Payer: GEHA Commercial |
$2,718.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,494.70
|
| Rate for Payer: Multiplan All |
$3,533.53
|
| Rate for Payer: OMNI Networks Commercial |
$2,718.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,494.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,688.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,912.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,611.19
|
| Rate for Payer: Zelis Auto |
$1,553.20
|
| Rate for Payer: Zelis Worker's Compensation |
$417.91
|
|
|
MRA HEAD W/WO CONT
|
Facility
|
IP
|
$5,408.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
2070546
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$679.85 |
| Max. Negotiated Rate |
$5,137.60 |
| Rate for Payer: Cash Price |
$3,244.80
|
| Rate for Payer: Cash Price |
$3,244.80
|
| Rate for Payer: Cigna Commercial |
$4,596.80
|
| Rate for Payer: First Health Commercial |
$4,867.20
|
| Rate for Payer: First Health Workers Compensation |
$961.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,867.20
|
| Rate for Payer: GEHA Commercial |
$3,785.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,867.20
|
| Rate for Payer: Multiplan All |
$4,921.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,785.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,867.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,137.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,056.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,029.44
|
| Rate for Payer: Zelis Auto |
$2,163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$679.85
|
|
|
MRA HEAD W/WO CONT
|
Facility
|
OP
|
$5,408.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
2070546
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,137.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,244.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,244.80
|
| Rate for Payer: Cash Price |
$3,244.80
|
| Rate for Payer: Cigna Commercial |
$4,596.80
|
| Rate for Payer: First Health Commercial |
$4,867.20
|
| Rate for Payer: First Health Workers Compensation |
$961.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,867.20
|
| Rate for Payer: GEHA Commercial |
$4,326.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,867.20
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,921.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,785.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,867.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,137.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,056.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,596.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,029.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,163.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$679.85
|
|
|
MRA LE W/CON
|
Facility
|
IP
|
$5,289.00
|
|
|
Service Code
|
CPT C8912
|
| Hospital Charge Code |
2000185
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,443.90 |
| Max. Negotiated Rate |
$5,024.55 |
| Rate for Payer: Cash Price |
$3,173.40
|
| Rate for Payer: Cigna Commercial |
$4,495.65
|
| Rate for Payer: First Health Commercial |
$4,760.10
|
| Rate for Payer: First Health Workers Compensation |
$2,042.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,760.10
|
| Rate for Payer: GEHA Commercial |
$3,702.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,760.10
|
| Rate for Payer: Multiplan All |
$4,812.99
|
| Rate for Payer: OMNI Networks Commercial |
$3,702.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,760.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,024.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,966.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,918.77
|
| Rate for Payer: Zelis Auto |
$2,115.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,443.90
|
|
|
MRA LE W/CON
|
Facility
|
OP
|
$5,289.00
|
|
|
Service Code
|
CPT C8912
|
| Hospital Charge Code |
2000185
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,024.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,173.40
|
| Rate for Payer: Cash Price |
$3,173.40
|
| Rate for Payer: Cigna Commercial |
$4,495.65
|
| Rate for Payer: First Health Commercial |
$4,760.10
|
| Rate for Payer: First Health Workers Compensation |
$2,042.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,760.10
|
| Rate for Payer: GEHA Commercial |
$4,231.20
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,760.10
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,812.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,702.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,760.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,024.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,966.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,495.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,918.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,115.60
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$1,443.90
|
|
|
MRA LE W/WO CONT
|
Facility
|
OP
|
$5,804.00
|
|
|
Service Code
|
CPT C8914
|
| Hospital Charge Code |
2002028
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,513.80 |
| 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 |
$3,482.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,482.40
|
| Rate for Payer: Cash Price |
$3,482.40
|
| Rate for Payer: Cigna Commercial |
$4,933.40
|
| Rate for Payer: First Health Commercial |
$5,223.60
|
| Rate for Payer: First Health Workers Compensation |
$2,240.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,223.60
|
| Rate for Payer: GEHA Commercial |
$4,643.20
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,223.60
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$5,281.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,062.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,223.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,513.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,353.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,933.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,397.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,321.60
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$1,584.49
|
|
|
MRA LE W/WO CONT
|
Facility
|
IP
|
$5,804.00
|
|
|
Service Code
|
CPT C8914
|
| Hospital Charge Code |
2002028
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,584.49 |
| Max. Negotiated Rate |
$5,513.80 |
| Rate for Payer: Cash Price |
$3,482.40
|
| Rate for Payer: Cigna Commercial |
$4,933.40
|
| Rate for Payer: First Health Commercial |
$5,223.60
|
| Rate for Payer: First Health Workers Compensation |
$2,240.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,223.60
|
| Rate for Payer: GEHA Commercial |
$4,062.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,223.60
|
| Rate for Payer: Multiplan All |
$5,281.64
|
| Rate for Payer: OMNI Networks Commercial |
$4,062.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,223.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,513.80
|
| Rate for Payer: Three Rivers Provider Network All |
$4,353.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,397.72
|
| Rate for Payer: Zelis Auto |
$2,321.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,584.49
|
|
|
MRA LOW EXT W/O CONT
|
Facility
|
OP
|
$4,080.00
|
|
|
Service Code
|
CPT C8913
|
| Hospital Charge Code |
2002023
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,876.00 |
| 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 |
$2,448.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cigna Commercial |
$3,468.00
|
| Rate for Payer: First Health Commercial |
$3,672.00
|
| Rate for Payer: First Health Workers Compensation |
$1,575.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,672.00
|
| Rate for Payer: GEHA Commercial |
$3,264.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,672.00
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,712.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,856.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,672.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,876.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,060.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,468.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,794.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,632.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$1,113.84
|
|
|
MRA LOW EXT W/O CONT
|
Facility
|
IP
|
$4,080.00
|
|
|
Service Code
|
CPT C8913
|
| Hospital Charge Code |
2002023
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cigna Commercial |
$3,468.00
|
| Rate for Payer: First Health Commercial |
$3,672.00
|
| Rate for Payer: First Health Workers Compensation |
$1,575.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,672.00
|
| Rate for Payer: GEHA Commercial |
$2,856.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,672.00
|
| Rate for Payer: Multiplan All |
$3,712.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,856.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,672.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,876.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,060.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,794.40
|
| Rate for Payer: Zelis Auto |
$1,632.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,113.84
|
|
|
MRA NECK W/CON
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
2001004
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$3,857.00 |
| 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 |
$2,436.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$646.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$3,248.00
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$3,694.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$3,451.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,775.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$457.46
|
|
|
MRA NECK W/CON
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
2001004
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$457.46 |
| Max. Negotiated Rate |
$3,857.00 |
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$646.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$2,842.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| Rate for Payer: Multiplan All |
$3,694.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,775.80
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Worker's Compensation |
$457.46
|
|
|
MRA NECK W/O
|
Facility
|
IP
|
$3,820.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
2001116
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$410.33 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cigna Commercial |
$3,247.00
|
| Rate for Payer: First Health Commercial |
$3,438.00
|
| Rate for Payer: First Health Workers Compensation |
$580.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,438.00
|
| Rate for Payer: GEHA Commercial |
$2,674.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,438.00
|
| Rate for Payer: Multiplan All |
$3,476.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,674.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,438.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,629.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,865.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,552.60
|
| Rate for Payer: Zelis Auto |
$1,528.00
|
| Rate for Payer: Zelis Worker's Compensation |
$410.33
|
|
|
MRA NECK W/O
|
Facility
|
OP
|
$3,820.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
2001116
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,292.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cigna Commercial |
$3,247.00
|
| Rate for Payer: First Health Commercial |
$3,438.00
|
| Rate for Payer: First Health Workers Compensation |
$580.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,438.00
|
| Rate for Payer: GEHA Commercial |
$3,056.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,438.00
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,476.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,674.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,438.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,629.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,865.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,247.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,552.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,528.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$410.33
|
|
|
MRA NECK W/O CONTRST MATERIAL
|
Facility
|
IP
|
$3,820.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
2470547
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$410.33 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cigna Commercial |
$3,247.00
|
| Rate for Payer: First Health Commercial |
$3,438.00
|
| Rate for Payer: First Health Workers Compensation |
$580.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,438.00
|
| Rate for Payer: GEHA Commercial |
$2,674.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,438.00
|
| Rate for Payer: Multiplan All |
$3,476.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,674.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,438.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,629.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,865.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,552.60
|
| Rate for Payer: Zelis Auto |
$1,528.00
|
| Rate for Payer: Zelis Worker's Compensation |
$410.33
|
|
|
MRA NECK W/O CONTRST MATERIAL
|
Facility
|
OP
|
$3,820.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
2470547
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,292.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cigna Commercial |
$3,247.00
|
| Rate for Payer: First Health Commercial |
$3,438.00
|
| Rate for Payer: First Health Workers Compensation |
$580.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,438.00
|
| Rate for Payer: GEHA Commercial |
$3,056.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,438.00
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,476.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,674.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,438.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,629.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,865.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,247.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,552.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,528.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$410.33
|
|
|
MRA NECK W/WO
|
Facility
|
OP
|
$5,016.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
2001111
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$4,765.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,009.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,009.60
|
| Rate for Payer: Cash Price |
$3,009.60
|
| Rate for Payer: Cigna Commercial |
$4,263.60
|
| Rate for Payer: First Health Commercial |
$4,514.40
|
| Rate for Payer: First Health Workers Compensation |
$897.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,514.40
|
| Rate for Payer: GEHA Commercial |
$4,012.80
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,514.40
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,564.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,511.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,514.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,765.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,762.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,263.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,664.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,006.40
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$634.56
|
|
|
MRA NECK W/WO
|
Facility
|
IP
|
$5,016.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
2001111
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$634.56 |
| Max. Negotiated Rate |
$4,765.20 |
| Rate for Payer: Cash Price |
$3,009.60
|
| Rate for Payer: Cash Price |
$3,009.60
|
| Rate for Payer: Cigna Commercial |
$4,263.60
|
| Rate for Payer: First Health Commercial |
$4,514.40
|
| Rate for Payer: First Health Workers Compensation |
$897.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,514.40
|
| Rate for Payer: GEHA Commercial |
$3,511.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,514.40
|
| Rate for Payer: Multiplan All |
$4,564.56
|
| Rate for Payer: OMNI Networks Commercial |
$3,511.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,514.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,765.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,762.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,664.88
|
| Rate for Payer: Zelis Auto |
$2,006.40
|
| Rate for Payer: Zelis Worker's Compensation |
$634.56
|
|
|
MRA PELVIS W/CONT
|
Facility
|
OP
|
$3,441.00
|
|
|
Service Code
|
CPT C8918
|
| Hospital Charge Code |
2000188
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$3,268.95 |
| 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 |
$2,064.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cigna Commercial |
$2,924.85
|
| Rate for Payer: First Health Commercial |
$3,096.90
|
| Rate for Payer: First Health Workers Compensation |
$1,328.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,096.90
|
| Rate for Payer: GEHA Commercial |
$2,752.80
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,096.90
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$3,131.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,408.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,096.90
|
| 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 |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,268.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,580.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$2,924.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,200.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,376.40
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$939.39
|
|
|
MRA PELVIS W/CONT
|
Facility
|
IP
|
$3,441.00
|
|
|
Service Code
|
CPT C8918
|
| Hospital Charge Code |
2000188
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$939.39 |
| Max. Negotiated Rate |
$3,268.95 |
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cigna Commercial |
$2,924.85
|
| Rate for Payer: First Health Commercial |
$3,096.90
|
| Rate for Payer: First Health Workers Compensation |
$1,328.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,096.90
|
| Rate for Payer: GEHA Commercial |
$2,408.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,096.90
|
| Rate for Payer: Multiplan All |
$3,131.31
|
| Rate for Payer: OMNI Networks Commercial |
$2,408.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,096.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,268.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,580.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,200.13
|
| Rate for Payer: Zelis Auto |
$1,376.40
|
| Rate for Payer: Zelis Worker's Compensation |
$939.39
|
|
|
MRA PELVIS W/O CONT
|
Facility
|
OP
|
$3,195.00
|
|
|
Service Code
|
CPT C8919
|
| Hospital Charge Code |
2002024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,035.25 |
| 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 |
$1,917.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$1,917.00
|
| Rate for Payer: Cash Price |
$1,917.00
|
| Rate for Payer: Cigna Commercial |
$2,715.75
|
| Rate for Payer: First Health Commercial |
$2,875.50
|
| Rate for Payer: First Health Workers Compensation |
$1,233.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,875.50
|
| Rate for Payer: GEHA Commercial |
$2,556.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,875.50
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$2,907.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,236.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,875.50
|
| 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 |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,035.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,396.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$2,715.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,971.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,278.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$872.24
|
|
|
MRA PELVIS W/O CONT
|
Facility
|
IP
|
$3,195.00
|
|
|
Service Code
|
CPT C8919
|
| Hospital Charge Code |
2002024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$872.24 |
| Max. Negotiated Rate |
$3,035.25 |
| Rate for Payer: Cash Price |
$1,917.00
|
| Rate for Payer: Cigna Commercial |
$2,715.75
|
| Rate for Payer: First Health Commercial |
$2,875.50
|
| Rate for Payer: First Health Workers Compensation |
$1,233.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,875.50
|
| Rate for Payer: GEHA Commercial |
$2,236.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,875.50
|
| Rate for Payer: Multiplan All |
$2,907.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,236.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,875.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,035.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,396.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,971.35
|
| Rate for Payer: Zelis Auto |
$1,278.00
|
| Rate for Payer: Zelis Worker's Compensation |
$872.24
|
|
|
MRI ABDOMEN W/CONT
|
Facility
|
IP
|
$4,503.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
2000186
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$482.38 |
| Max. Negotiated Rate |
$4,277.85 |
| Rate for Payer: Cash Price |
$2,701.80
|
| Rate for Payer: Cash Price |
$2,701.80
|
| Rate for Payer: Cigna Commercial |
$3,827.55
|
| Rate for Payer: First Health Commercial |
$4,052.70
|
| Rate for Payer: First Health Workers Compensation |
$682.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,052.70
|
| Rate for Payer: GEHA Commercial |
$3,152.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,052.70
|
| Rate for Payer: Multiplan All |
$4,097.73
|
| Rate for Payer: OMNI Networks Commercial |
$3,152.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,052.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,277.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,377.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,187.79
|
| Rate for Payer: Zelis Auto |
$1,801.20
|
| Rate for Payer: Zelis Worker's Compensation |
$482.38
|
|
|
MRI ABDOMEN W/CONT
|
Facility
|
OP
|
$4,503.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
2000186
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$4,277.85 |
| 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 |
$2,701.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$2,701.80
|
| Rate for Payer: Cash Price |
$2,701.80
|
| Rate for Payer: Cigna Commercial |
$3,827.55
|
| Rate for Payer: First Health Commercial |
$4,052.70
|
| Rate for Payer: First Health Workers Compensation |
$682.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,052.70
|
| Rate for Payer: GEHA Commercial |
$3,602.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,052.70
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,097.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,152.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,052.70
|
| 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 |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,277.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,377.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$3,827.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,187.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,801.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$482.38
|
|
|
MRI ABD W/O
|
Facility
|
IP
|
$4,100.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
2000157
|
|
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
|
|
