|
MRI ABD W/O
|
Facility
|
OP
|
$4,100.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
2000157
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,895.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,460.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,460.00
|
| Rate for Payer: Cash Price |
$2,460.00
|
| Rate for Payer: Cigna Commercial |
$3,485.00
|
| Rate for Payer: First Health Commercial |
$3,690.00
|
| Rate for Payer: First Health Workers Compensation |
$555.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,690.00
|
| Rate for Payer: GEHA Commercial |
$3,280.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,690.00
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,731.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,870.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,690.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,895.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,075.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,485.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,813.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,640.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$393.06
|
|
|
MRI ABD W/WO
|
Facility
|
IP
|
$5,576.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
2002025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$620.91 |
| Max. Negotiated Rate |
$5,297.20 |
| Rate for Payer: Cash Price |
$3,345.60
|
| Rate for Payer: Cash Price |
$3,345.60
|
| Rate for Payer: Cigna Commercial |
$4,739.60
|
| Rate for Payer: First Health Commercial |
$5,018.40
|
| Rate for Payer: First Health Workers Compensation |
$878.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,018.40
|
| Rate for Payer: GEHA Commercial |
$3,903.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,018.40
|
| Rate for Payer: Multiplan All |
$5,074.16
|
| Rate for Payer: OMNI Networks Commercial |
$3,903.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,018.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,297.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,182.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,185.68
|
| Rate for Payer: Zelis Auto |
$2,230.40
|
| Rate for Payer: Zelis Worker's Compensation |
$620.91
|
|
|
MRI ABD W/WO
|
Facility
|
OP
|
$5,576.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
2002025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,297.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,345.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,345.60
|
| Rate for Payer: Cash Price |
$3,345.60
|
| Rate for Payer: Cigna Commercial |
$4,739.60
|
| Rate for Payer: First Health Commercial |
$5,018.40
|
| Rate for Payer: First Health Workers Compensation |
$878.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,018.40
|
| Rate for Payer: GEHA Commercial |
$4,460.80
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,018.40
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$5,074.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,903.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,018.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,297.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,182.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,739.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,185.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,230.40
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$620.91
|
|
|
MRI ANGIO ABD W/O
|
Facility
|
IP
|
$3,837.00
|
|
|
Service Code
|
CPT C8901
|
| Hospital Charge Code |
2001001
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,047.50 |
| Max. Negotiated Rate |
$3,645.15 |
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Cigna Commercial |
$3,261.45
|
| Rate for Payer: First Health Commercial |
$3,453.30
|
| Rate for Payer: First Health Workers Compensation |
$1,481.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,453.30
|
| Rate for Payer: GEHA Commercial |
$2,685.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,453.30
|
| Rate for Payer: Multiplan All |
$3,491.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,685.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,453.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,645.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,877.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,568.41
|
| Rate for Payer: Zelis Auto |
$1,534.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,047.50
|
|
|
MRI ANGIO ABD W/O
|
Facility
|
OP
|
$3,837.00
|
|
|
Service Code
|
CPT C8901
|
| Hospital Charge Code |
2001001
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,645.15 |
| 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 |
$2,302.20
|
| 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 |
$229.52
|
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Cigna Commercial |
$3,261.45
|
| Rate for Payer: First Health Commercial |
$3,453.30
|
| Rate for Payer: First Health Workers Compensation |
$1,481.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,453.30
|
| Rate for Payer: GEHA Commercial |
$3,069.60
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,453.30
|
| 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 |
$3,491.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,685.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,453.30
|
| 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 |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,645.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,877.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,261.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,568.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,534.80
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$1,047.50
|
|
|
MRI ANGIO LOW EX WWO
|
Facility
|
OP
|
$5,804.00
|
|
|
Service Code
|
CPT C8914
|
| Hospital Charge Code |
2000161
|
|
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
|
|
|
MRI ANGIO LOW EX WWO
|
Facility
|
IP
|
$5,804.00
|
|
|
Service Code
|
CPT C8914
|
| Hospital Charge Code |
2000161
|
|
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
|
|
|
MRI BRAIN W/CONT
|
Facility
|
IP
|
$4,734.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
2000164
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$470.08 |
| Max. Negotiated Rate |
$4,497.30 |
| Rate for Payer: Cash Price |
$2,840.40
|
| Rate for Payer: Cash Price |
$2,840.40
|
| Rate for Payer: Cigna Commercial |
$4,023.90
|
| Rate for Payer: First Health Commercial |
$4,260.60
|
| Rate for Payer: First Health Workers Compensation |
$664.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,260.60
|
| Rate for Payer: GEHA Commercial |
$3,313.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,260.60
|
| Rate for Payer: Multiplan All |
$4,307.94
|
| Rate for Payer: OMNI Networks Commercial |
$3,313.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,260.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,497.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,550.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,402.62
|
| Rate for Payer: Zelis Auto |
$1,893.60
|
| Rate for Payer: Zelis Worker's Compensation |
$470.08
|
|
|
MRI BRAIN W/CONT
|
Facility
|
OP
|
$4,734.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
2000164
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$4,497.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,840.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$2,840.40
|
| Rate for Payer: Cash Price |
$2,840.40
|
| Rate for Payer: Cigna Commercial |
$4,023.90
|
| Rate for Payer: First Health Commercial |
$4,260.60
|
| Rate for Payer: First Health Workers Compensation |
$664.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,260.60
|
| Rate for Payer: GEHA Commercial |
$3,787.20
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,260.60
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,307.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,313.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,260.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,497.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,550.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,023.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,402.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,893.60
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$470.08
|
|
|
MRI BRAIN W/O
|
Facility
|
OP
|
$4,331.50
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
2000166
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$4,114.93 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,598.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,598.90
|
| Rate for Payer: Cash Price |
$2,598.90
|
| Rate for Payer: Cigna Commercial |
$3,681.78
|
| Rate for Payer: First Health Commercial |
$3,898.35
|
| Rate for Payer: First Health Workers Compensation |
$581.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,898.35
|
| Rate for Payer: GEHA Commercial |
$3,465.20
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,898.35
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,941.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$3,032.05
|
| Rate for Payer: One Health Plan PPO/POS |
$3,898.35
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,114.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,248.62
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,681.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,028.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,732.60
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$411.17
|
|
|
MRI BRAIN W/O
|
Facility
|
IP
|
$4,331.50
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
2000166
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$411.17 |
| Max. Negotiated Rate |
$4,114.93 |
| Rate for Payer: Cash Price |
$2,598.90
|
| Rate for Payer: Cash Price |
$2,598.90
|
| Rate for Payer: Cigna Commercial |
$3,681.78
|
| Rate for Payer: First Health Commercial |
$3,898.35
|
| Rate for Payer: First Health Workers Compensation |
$581.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,898.35
|
| Rate for Payer: GEHA Commercial |
$3,032.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,898.35
|
| Rate for Payer: Multiplan All |
$3,941.66
|
| Rate for Payer: OMNI Networks Commercial |
$3,032.05
|
| Rate for Payer: One Health Plan PPO/POS |
$3,898.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,114.93
|
| Rate for Payer: Three Rivers Provider Network All |
$3,248.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,028.30
|
| Rate for Payer: Zelis Auto |
$1,732.60
|
| Rate for Payer: Zelis Worker's Compensation |
$411.17
|
|
|
MRI BRAIN W/WO
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
2000165
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$582.86 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cigna Commercial |
$5,100.00
|
| Rate for Payer: First Health Commercial |
$5,400.00
|
| Rate for Payer: First Health Workers Compensation |
$824.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,400.00
|
| Rate for Payer: GEHA Commercial |
$4,200.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,400.00
|
| Rate for Payer: Multiplan All |
$5,460.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,200.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,400.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,700.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,500.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,580.00
|
| Rate for Payer: Zelis Auto |
$2,400.00
|
| Rate for Payer: Zelis Worker's Compensation |
$582.86
|
|
|
MRI BRAIN W/WO
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
2000165
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cigna Commercial |
$5,100.00
|
| Rate for Payer: First Health Commercial |
$5,400.00
|
| Rate for Payer: First Health Workers Compensation |
$824.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,400.00
|
| Rate for Payer: GEHA Commercial |
$4,800.00
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,400.00
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$5,460.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,200.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,400.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,700.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,500.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$5,100.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,580.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,400.00
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$582.86
|
|
|
MRI BREAST C- BILATERAL
|
Facility
|
OP
|
$4,462.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
2000192
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$4,238.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$345.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,677.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$345.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$273.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,677.20
|
| Rate for Payer: Cash Price |
$2,677.20
|
| Rate for Payer: Cigna Commercial |
$3,792.70
|
| Rate for Payer: First Health Commercial |
$4,015.80
|
| Rate for Payer: First Health Workers Compensation |
$329.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,015.80
|
| Rate for Payer: GEHA Commercial |
$3,569.60
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,015.80
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$4,060.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$3,123.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,015.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$322.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,238.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,346.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,792.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,149.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,784.80
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$232.95
|
|
|
MRI BREAST C- BILATERAL
|
Facility
|
IP
|
$4,462.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
2000192
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$232.95 |
| Max. Negotiated Rate |
$4,238.90 |
| Rate for Payer: Cash Price |
$2,677.20
|
| Rate for Payer: Cash Price |
$2,677.20
|
| Rate for Payer: Cigna Commercial |
$3,792.70
|
| Rate for Payer: First Health Commercial |
$4,015.80
|
| Rate for Payer: First Health Workers Compensation |
$329.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,015.80
|
| Rate for Payer: GEHA Commercial |
$3,123.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,015.80
|
| Rate for Payer: Multiplan All |
$4,060.42
|
| Rate for Payer: OMNI Networks Commercial |
$3,123.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,015.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,238.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,346.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,149.66
|
| Rate for Payer: Zelis Auto |
$1,784.80
|
| Rate for Payer: Zelis Worker's Compensation |
$232.95
|
|
|
MRI BREAST WITHOUT CONTRAST MATERIAL BIL
|
Facility
|
IP
|
$4,462.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
2400113
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$232.95 |
| Max. Negotiated Rate |
$4,238.90 |
| Rate for Payer: Cash Price |
$2,677.20
|
| Rate for Payer: Cash Price |
$2,677.20
|
| Rate for Payer: Cigna Commercial |
$3,792.70
|
| Rate for Payer: First Health Commercial |
$4,015.80
|
| Rate for Payer: First Health Workers Compensation |
$329.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,015.80
|
| Rate for Payer: GEHA Commercial |
$3,123.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,015.80
|
| Rate for Payer: Multiplan All |
$4,060.42
|
| Rate for Payer: OMNI Networks Commercial |
$3,123.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,015.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,238.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,346.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,149.66
|
| Rate for Payer: Zelis Auto |
$1,784.80
|
| Rate for Payer: Zelis Worker's Compensation |
$232.95
|
|
|
MRI BREAST WITHOUT CONTRAST MATERIAL BIL
|
Facility
|
OP
|
$4,462.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
2400113
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$4,238.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$345.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,677.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$345.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$273.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,677.20
|
| Rate for Payer: Cash Price |
$2,677.20
|
| Rate for Payer: Cigna Commercial |
$3,792.70
|
| Rate for Payer: First Health Commercial |
$4,015.80
|
| Rate for Payer: First Health Workers Compensation |
$329.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,015.80
|
| Rate for Payer: GEHA Commercial |
$3,569.60
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,015.80
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$4,060.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$3,123.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,015.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$322.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,238.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,346.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,792.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,149.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,784.80
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$232.95
|
|
|
MRI BREAST WITHOUT CONTRAST MATERIAL UNI
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
2400112
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$345.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,620.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$345.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$273.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cigna Commercial |
$2,295.00
|
| Rate for Payer: First Health Commercial |
$2,430.00
|
| Rate for Payer: First Health Workers Compensation |
$320.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,430.00
|
| Rate for Payer: GEHA Commercial |
$2,160.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,430.00
|
| 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 |
$279.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$2,457.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,890.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,430.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$322.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,565.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,025.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$2,295.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,511.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,080.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$226.88
|
|
|
MRI BREAST WITHOUT CONTRAST MATERIAL UNI
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
2400112
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$226.88 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cigna Commercial |
$2,295.00
|
| Rate for Payer: First Health Commercial |
$2,430.00
|
| Rate for Payer: First Health Workers Compensation |
$320.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,430.00
|
| Rate for Payer: GEHA Commercial |
$1,890.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,430.00
|
| Rate for Payer: Multiplan All |
$2,457.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,890.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,430.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,565.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,025.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,511.00
|
| Rate for Payer: Zelis Auto |
$1,080.00
|
| Rate for Payer: Zelis Worker's Compensation |
$226.88
|
|
|
MRI BREAST W/WO BILATERAL
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
2000193
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$368.06 |
| Max. Negotiated Rate |
$3,257.55 |
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cigna Commercial |
$2,914.65
|
| Rate for Payer: First Health Commercial |
$3,086.10
|
| Rate for Payer: First Health Workers Compensation |
$520.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,086.10
|
| Rate for Payer: GEHA Commercial |
$2,400.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,086.10
|
| Rate for Payer: Multiplan All |
$3,120.39
|
| Rate for Payer: OMNI Networks Commercial |
$2,400.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,086.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,257.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.97
|
| Rate for Payer: Zelis Auto |
$1,371.60
|
| Rate for Payer: Zelis Worker's Compensation |
$368.06
|
|
|
MRI BREAST W/WO BILATERAL
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
2000193
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$368.06 |
| Max. Negotiated Rate |
$3,257.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cigna Commercial |
$2,914.65
|
| Rate for Payer: First Health Commercial |
$3,086.10
|
| Rate for Payer: First Health Workers Compensation |
$520.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,086.10
|
| Rate for Payer: GEHA Commercial |
$2,743.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,086.10
|
| Rate for Payer: Humana ChoiceCare |
$891.54
|
| Rate for Payer: Multiplan All |
$3,120.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,057.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,400.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,086.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,257.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.52
|
| Rate for Payer: United Healthcare Commercial |
$2,914.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$857.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.97
|
| Rate for Payer: Zelis Auto |
$1,371.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,714.50
|
| Rate for Payer: Zelis Worker's Compensation |
$368.06
|
|
|
MRI BREAST W/WO UNILATERAL
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
2077048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$360.02 |
| Max. Negotiated Rate |
$1,059.25 |
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$509.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$780.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Worker's Compensation |
$360.02
|
|
|
MRI BREAST W/WO UNILATERAL
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
2077048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$1,059.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$509.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$892.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Humana ChoiceCare |
$289.90
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$669.00
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$981.20
|
| Rate for Payer: United Healthcare Commercial |
$947.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$278.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$557.50
|
| Rate for Payer: Zelis Worker's Compensation |
$360.02
|
|
|
MRI CHEST W/ CONT
|
Facility
|
IP
|
$3,971.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
2002011
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$486.14 |
| Max. Negotiated Rate |
$3,772.45 |
| Rate for Payer: Cash Price |
$2,382.60
|
| Rate for Payer: Cash Price |
$2,382.60
|
| Rate for Payer: Cigna Commercial |
$3,375.35
|
| Rate for Payer: First Health Commercial |
$3,573.90
|
| Rate for Payer: First Health Workers Compensation |
$687.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,573.90
|
| Rate for Payer: GEHA Commercial |
$2,779.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,573.90
|
| Rate for Payer: Multiplan All |
$3,613.61
|
| Rate for Payer: OMNI Networks Commercial |
$2,779.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,573.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,772.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,978.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,693.03
|
| Rate for Payer: Zelis Auto |
$1,588.40
|
| Rate for Payer: Zelis Worker's Compensation |
$486.14
|
|
|
MRI CHEST W/ CONT
|
Facility
|
OP
|
$3,971.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
2002011
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$486.14 |
| Max. Negotiated Rate |
$3,772.45 |
| 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 |
$2,382.60
|
| 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 |
$750.19
|
| Rate for Payer: Cash Price |
$2,382.60
|
| Rate for Payer: Cash Price |
$2,382.60
|
| Rate for Payer: Cigna Commercial |
$3,375.35
|
| Rate for Payer: First Health Commercial |
$3,573.90
|
| Rate for Payer: First Health Workers Compensation |
$687.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,573.90
|
| Rate for Payer: GEHA Commercial |
$3,176.80
|
| Rate for Payer: GEHA Medicare |
$750.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,573.90
|
| Rate for Payer: Humana ChoiceCare |
$825.21
|
| Rate for Payer: Humana Medicare Advantage |
$750.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,260.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$750.19
|
| Rate for Payer: Multiplan All |
$3,613.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,275.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,779.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,573.90
|
| 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 |
$750.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,772.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,500.38
|
| Rate for Payer: Three Rivers Provider Network All |
$2,978.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$735.19
|
| Rate for Payer: United Healthcare Commercial |
$3,375.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,693.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$750.19
|
| Rate for Payer: Zelis Auto |
$1,588.40
|
| Rate for Payer: Zelis Medicare |
$637.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$900.23
|
| Rate for Payer: Zelis Worker's Compensation |
$486.14
|
|
