|
MRI CHEST W/O CON
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
2000172
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$430.58 |
| Max. Negotiated Rate |
$3,686.95 |
| Rate for Payer: Cash Price |
$2,328.60
|
| Rate for Payer: Cash Price |
$2,328.60
|
| Rate for Payer: Cigna Commercial |
$3,298.85
|
| Rate for Payer: First Health Commercial |
$3,492.90
|
| Rate for Payer: First Health Workers Compensation |
$608.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,492.90
|
| Rate for Payer: GEHA Commercial |
$2,716.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,492.90
|
| Rate for Payer: Multiplan All |
$3,531.71
|
| Rate for Payer: OMNI Networks Commercial |
$2,716.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,492.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,686.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,910.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,609.33
|
| Rate for Payer: Zelis Auto |
$1,552.40
|
| Rate for Payer: Zelis Worker's Compensation |
$430.58
|
|
|
MRI CHEST W/O CON
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
2000172
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$199.09 |
| Max. Negotiated Rate |
$3,686.95 |
| 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 |
$2,328.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$234.22
|
| Rate for Payer: Cash Price |
$2,328.60
|
| Rate for Payer: Cash Price |
$2,328.60
|
| Rate for Payer: Cigna Commercial |
$3,298.85
|
| Rate for Payer: First Health Commercial |
$3,492.90
|
| Rate for Payer: First Health Workers Compensation |
$608.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,492.90
|
| Rate for Payer: GEHA Commercial |
$3,104.80
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,492.90
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$3,531.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,716.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,492.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,686.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$2,910.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$3,298.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,609.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$1,552.40
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$430.58
|
|
|
MRI CHEST W/WO CON
|
Facility
|
IP
|
$5,343.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
2002012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$644.86 |
| Max. Negotiated Rate |
$5,075.85 |
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cigna Commercial |
$4,541.55
|
| Rate for Payer: First Health Commercial |
$4,808.70
|
| Rate for Payer: First Health Workers Compensation |
$912.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,808.70
|
| Rate for Payer: GEHA Commercial |
$3,740.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,808.70
|
| Rate for Payer: Multiplan All |
$4,862.13
|
| Rate for Payer: OMNI Networks Commercial |
$3,740.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,808.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,075.85
|
| Rate for Payer: Three Rivers Provider Network All |
$4,007.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,968.99
|
| Rate for Payer: Zelis Auto |
$2,137.20
|
| Rate for Payer: Zelis Worker's Compensation |
$644.86
|
|
|
MRI CHEST W/WO CON
|
Facility
|
OP
|
$5,343.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
2002012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$5,075.85 |
| 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 |
$3,205.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$346.05
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cigna Commercial |
$4,541.55
|
| Rate for Payer: First Health Commercial |
$4,808.70
|
| Rate for Payer: First Health Workers Compensation |
$912.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,808.70
|
| Rate for Payer: GEHA Commercial |
$4,274.40
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,808.70
|
| Rate for Payer: Humana ChoiceCare |
$380.65
|
| Rate for Payer: Humana Medicare Advantage |
$346.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$581.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$346.05
|
| Rate for Payer: Multiplan All |
$4,862.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,740.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,808.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,075.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,007.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$4,541.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,968.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$2,137.20
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$644.86
|
|
|
MRI C-SPINE W/CON
|
Facility
|
IP
|
$4,554.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
2000169
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$474.99 |
| Max. Negotiated Rate |
$4,326.30 |
| Rate for Payer: Cash Price |
$2,732.40
|
| Rate for Payer: Cash Price |
$2,732.40
|
| Rate for Payer: Cigna Commercial |
$3,870.90
|
| Rate for Payer: First Health Commercial |
$4,098.60
|
| Rate for Payer: First Health Workers Compensation |
$671.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,098.60
|
| Rate for Payer: GEHA Commercial |
$3,187.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,098.60
|
| Rate for Payer: Multiplan All |
$4,144.14
|
| Rate for Payer: OMNI Networks Commercial |
$3,187.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,098.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,326.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,415.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,235.22
|
| Rate for Payer: Zelis Auto |
$1,821.60
|
| Rate for Payer: Zelis Worker's Compensation |
$474.99
|
|
|
MRI C-SPINE W/CON
|
Facility
|
OP
|
$4,554.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
2000169
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$4,326.30 |
| 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 |
$2,732.40
|
| 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 |
$346.05
|
| Rate for Payer: Cash Price |
$2,732.40
|
| Rate for Payer: Cash Price |
$2,732.40
|
| Rate for Payer: Cigna Commercial |
$3,870.90
|
| Rate for Payer: First Health Commercial |
$4,098.60
|
| Rate for Payer: First Health Workers Compensation |
$671.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,098.60
|
| Rate for Payer: GEHA Commercial |
$3,643.20
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,098.60
|
| Rate for Payer: Humana ChoiceCare |
$380.65
|
| Rate for Payer: Humana Medicare Advantage |
$346.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$581.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$346.05
|
| Rate for Payer: Multiplan All |
$4,144.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,187.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,098.60
|
| 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 |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,326.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,415.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$3,870.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,235.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$1,821.60
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$474.99
|
|
|
MRI C-SPINE W/O
|
Facility
|
OP
|
$4,378.60
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
2000171
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$199.09 |
| Max. Negotiated Rate |
$4,159.67 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,627.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$234.22
|
| Rate for Payer: Cash Price |
$2,627.16
|
| Rate for Payer: Cash Price |
$2,627.16
|
| Rate for Payer: Cigna Commercial |
$3,721.81
|
| Rate for Payer: First Health Commercial |
$3,940.74
|
| Rate for Payer: First Health Workers Compensation |
$578.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,940.74
|
| Rate for Payer: GEHA Commercial |
$3,502.88
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,940.74
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$3,984.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$3,065.02
|
| Rate for Payer: One Health Plan PPO/POS |
$3,940.74
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,159.67
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$3,283.95
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$3,721.81
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,072.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$1,751.44
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$408.93
|
|
|
MRI C-SPINE W/O
|
Facility
|
IP
|
$4,378.60
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
2000171
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$408.93 |
| Max. Negotiated Rate |
$4,159.67 |
| Rate for Payer: Cash Price |
$2,627.16
|
| Rate for Payer: Cash Price |
$2,627.16
|
| Rate for Payer: Cigna Commercial |
$3,721.81
|
| Rate for Payer: First Health Commercial |
$3,940.74
|
| Rate for Payer: First Health Workers Compensation |
$578.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,940.74
|
| Rate for Payer: GEHA Commercial |
$3,065.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,940.74
|
| Rate for Payer: Multiplan All |
$3,984.53
|
| Rate for Payer: OMNI Networks Commercial |
$3,065.02
|
| Rate for Payer: One Health Plan PPO/POS |
$3,940.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,159.67
|
| Rate for Payer: Three Rivers Provider Network All |
$3,283.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,072.10
|
| Rate for Payer: Zelis Auto |
$1,751.44
|
| Rate for Payer: Zelis Worker's Compensation |
$408.93
|
|
|
MRI C-SPINE W/WO
|
Facility
|
OP
|
$5,835.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
2000170
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$5,543.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,501.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$346.05
|
| Rate for Payer: Cash Price |
$3,501.00
|
| Rate for Payer: Cash Price |
$3,501.00
|
| Rate for Payer: Cigna Commercial |
$4,959.75
|
| Rate for Payer: First Health Commercial |
$5,251.50
|
| Rate for Payer: First Health Workers Compensation |
$826.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,251.50
|
| Rate for Payer: GEHA Commercial |
$4,668.00
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,251.50
|
| Rate for Payer: Humana ChoiceCare |
$380.65
|
| Rate for Payer: Humana Medicare Advantage |
$346.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$581.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$346.05
|
| Rate for Payer: Multiplan All |
$5,309.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$4,084.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,251.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,543.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,376.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$4,959.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,426.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$2,334.00
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$584.23
|
|
|
MRI C-SPINE W/WO
|
Facility
|
IP
|
$5,835.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
2000170
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$584.23 |
| Max. Negotiated Rate |
$5,543.25 |
| Rate for Payer: Cash Price |
$3,501.00
|
| Rate for Payer: Cash Price |
$3,501.00
|
| Rate for Payer: Cigna Commercial |
$4,959.75
|
| Rate for Payer: First Health Commercial |
$5,251.50
|
| Rate for Payer: First Health Workers Compensation |
$826.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,251.50
|
| Rate for Payer: GEHA Commercial |
$4,084.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,251.50
|
| Rate for Payer: Multiplan All |
$5,309.85
|
| Rate for Payer: OMNI Networks Commercial |
$4,084.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,251.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,543.25
|
| Rate for Payer: Three Rivers Provider Network All |
$4,376.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,426.55
|
| Rate for Payer: Zelis Auto |
$2,334.00
|
| Rate for Payer: Zelis Worker's Compensation |
$584.23
|
|
|
MRI LE JNT W/CON
|
Facility
|
OP
|
$4,419.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
2410109
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.52 |
| Max. Negotiated Rate |
$4,198.05 |
| 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 |
$2,651.40
|
| 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 |
$765.55
|
| Rate for Payer: Cash Price |
$2,651.40
|
| Rate for Payer: Cash Price |
$2,651.40
|
| Rate for Payer: Cigna Commercial |
$3,756.15
|
| Rate for Payer: First Health Commercial |
$3,977.10
|
| Rate for Payer: First Health Workers Compensation |
$641.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,977.10
|
| Rate for Payer: GEHA Commercial |
$3,535.20
|
| Rate for Payer: GEHA Medicare |
$765.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,977.10
|
| Rate for Payer: Humana ChoiceCare |
$842.11
|
| Rate for Payer: Humana Medicare Advantage |
$765.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,286.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$765.55
|
| Rate for Payer: Multiplan All |
$4,021.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,301.43
|
| Rate for Payer: OMNI Networks Commercial |
$3,093.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,977.10
|
| 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 |
$765.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,198.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,531.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,314.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$750.24
|
| Rate for Payer: United Healthcare Commercial |
$3,756.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$765.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,109.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$765.55
|
| Rate for Payer: Zelis Auto |
$1,767.60
|
| Rate for Payer: Zelis Medicare |
$650.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$918.66
|
| Rate for Payer: Zelis Worker's Compensation |
$453.52
|
|
|
MRI LE JNT W/CON
|
Facility
|
IP
|
$4,419.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
2410109
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.52 |
| Max. Negotiated Rate |
$4,198.05 |
| Rate for Payer: Cash Price |
$2,651.40
|
| Rate for Payer: Cash Price |
$2,651.40
|
| Rate for Payer: Cigna Commercial |
$3,756.15
|
| Rate for Payer: First Health Commercial |
$3,977.10
|
| Rate for Payer: First Health Workers Compensation |
$641.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,977.10
|
| Rate for Payer: GEHA Commercial |
$3,093.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,977.10
|
| Rate for Payer: Multiplan All |
$4,021.29
|
| Rate for Payer: OMNI Networks Commercial |
$3,093.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,977.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,198.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,314.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,109.67
|
| Rate for Payer: Zelis Auto |
$1,767.60
|
| Rate for Payer: Zelis Worker's Compensation |
$453.52
|
|
|
MRI LE JNT W/CON RT
|
Facility
|
IP
|
$4,419.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
2000159
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.52 |
| Max. Negotiated Rate |
$4,198.05 |
| Rate for Payer: Cash Price |
$2,651.40
|
| Rate for Payer: Cash Price |
$2,651.40
|
| Rate for Payer: Cigna Commercial |
$3,756.15
|
| Rate for Payer: First Health Commercial |
$3,977.10
|
| Rate for Payer: First Health Workers Compensation |
$641.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,977.10
|
| Rate for Payer: GEHA Commercial |
$3,093.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,977.10
|
| Rate for Payer: Multiplan All |
$4,021.29
|
| Rate for Payer: OMNI Networks Commercial |
$3,093.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,977.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,198.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,314.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,109.67
|
| Rate for Payer: Zelis Auto |
$1,767.60
|
| Rate for Payer: Zelis Worker's Compensation |
$453.52
|
|
|
MRI LE JNT W/CON RT
|
Facility
|
OP
|
$4,419.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
2000159
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.52 |
| Max. Negotiated Rate |
$4,198.05 |
| 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 |
$2,651.40
|
| 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 |
$765.55
|
| Rate for Payer: Cash Price |
$2,651.40
|
| Rate for Payer: Cash Price |
$2,651.40
|
| Rate for Payer: Cigna Commercial |
$3,756.15
|
| Rate for Payer: First Health Commercial |
$3,977.10
|
| Rate for Payer: First Health Workers Compensation |
$641.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,977.10
|
| Rate for Payer: GEHA Commercial |
$3,535.20
|
| Rate for Payer: GEHA Medicare |
$765.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,977.10
|
| Rate for Payer: Humana ChoiceCare |
$842.11
|
| Rate for Payer: Humana Medicare Advantage |
$765.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,286.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$765.55
|
| Rate for Payer: Multiplan All |
$4,021.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,301.43
|
| Rate for Payer: OMNI Networks Commercial |
$3,093.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,977.10
|
| 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 |
$765.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,198.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,531.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,314.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$750.24
|
| Rate for Payer: United Healthcare Commercial |
$3,756.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$765.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,109.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$765.55
|
| Rate for Payer: Zelis Auto |
$1,767.60
|
| Rate for Payer: Zelis Medicare |
$650.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$918.66
|
| Rate for Payer: Zelis Worker's Compensation |
$453.52
|
|
|
MRI LE JNT W/O
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
2410108
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$399.38 |
| Max. Negotiated Rate |
$3,857.00 |
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$564.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$2,842.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| Rate for Payer: Multiplan All |
$3,694.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,775.80
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Worker's Compensation |
$399.38
|
|
|
MRI LE JNT W/O
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
2410108
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$199.09 |
| Max. Negotiated Rate |
$3,857.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,436.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$234.22
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$564.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$3,248.00
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$3,694.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$3,451.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,775.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$399.38
|
|
|
MRI LE JNT W/O RT
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
2001114
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$199.09 |
| Max. Negotiated Rate |
$3,857.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,436.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$234.22
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$564.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$3,248.00
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$3,694.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$3,451.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,775.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$399.38
|
|
|
MRI LE JNT W/O RT
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
2001114
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$399.38 |
| Max. Negotiated Rate |
$3,857.00 |
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$564.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$2,842.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| Rate for Payer: Multiplan All |
$3,694.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,775.80
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Worker's Compensation |
$399.38
|
|
|
MRI LE JNT W/WO
|
Facility
|
IP
|
$5,366.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
2000191
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$596.14 |
| Max. Negotiated Rate |
$5,097.70 |
| Rate for Payer: Cash Price |
$3,219.60
|
| Rate for Payer: Cash Price |
$3,219.60
|
| Rate for Payer: Cigna Commercial |
$4,561.10
|
| Rate for Payer: First Health Commercial |
$4,829.40
|
| Rate for Payer: First Health Workers Compensation |
$843.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,829.40
|
| Rate for Payer: GEHA Commercial |
$3,756.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,829.40
|
| Rate for Payer: Multiplan All |
$4,883.06
|
| Rate for Payer: OMNI Networks Commercial |
$3,756.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,829.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,097.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,024.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,990.38
|
| Rate for Payer: Zelis Auto |
$2,146.40
|
| Rate for Payer: Zelis Worker's Compensation |
$596.14
|
|
|
MRI LE JNT W/WO
|
Facility
|
OP
|
$5,366.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
2000191
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$5,097.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,219.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$346.05
|
| Rate for Payer: Cash Price |
$3,219.60
|
| Rate for Payer: Cash Price |
$3,219.60
|
| Rate for Payer: Cigna Commercial |
$4,561.10
|
| Rate for Payer: First Health Commercial |
$4,829.40
|
| Rate for Payer: First Health Workers Compensation |
$843.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,829.40
|
| Rate for Payer: GEHA Commercial |
$4,292.80
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,829.40
|
| Rate for Payer: Humana ChoiceCare |
$380.65
|
| Rate for Payer: Humana Medicare Advantage |
$346.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$581.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$346.05
|
| Rate for Payer: Multiplan All |
$4,883.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,756.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,829.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,097.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,024.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$4,561.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,990.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$2,146.40
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$596.14
|
|
|
MRI LE JNT W/WO RT
|
Facility
|
IP
|
$5,366.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
2000194
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$596.14 |
| Max. Negotiated Rate |
$5,097.70 |
| Rate for Payer: Cash Price |
$3,219.60
|
| Rate for Payer: Cash Price |
$3,219.60
|
| Rate for Payer: Cigna Commercial |
$4,561.10
|
| Rate for Payer: First Health Commercial |
$4,829.40
|
| Rate for Payer: First Health Workers Compensation |
$843.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,829.40
|
| Rate for Payer: GEHA Commercial |
$3,756.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,829.40
|
| Rate for Payer: Multiplan All |
$4,883.06
|
| Rate for Payer: OMNI Networks Commercial |
$3,756.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,829.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,097.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,024.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,990.38
|
| Rate for Payer: Zelis Auto |
$2,146.40
|
| Rate for Payer: Zelis Worker's Compensation |
$596.14
|
|
|
MRI LE JNT W/WO RT
|
Facility
|
OP
|
$5,366.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
2000194
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$5,097.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,219.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$346.05
|
| Rate for Payer: Cash Price |
$3,219.60
|
| Rate for Payer: Cash Price |
$3,219.60
|
| Rate for Payer: Cigna Commercial |
$4,561.10
|
| Rate for Payer: First Health Commercial |
$4,829.40
|
| Rate for Payer: First Health Workers Compensation |
$843.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,829.40
|
| Rate for Payer: GEHA Commercial |
$4,292.80
|
| Rate for Payer: GEHA Medicare |
$346.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,829.40
|
| Rate for Payer: Humana ChoiceCare |
$380.65
|
| Rate for Payer: Humana Medicare Advantage |
$346.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$581.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$346.05
|
| Rate for Payer: Multiplan All |
$4,883.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,756.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,829.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$346.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,097.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$692.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,024.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.13
|
| Rate for Payer: United Healthcare Commercial |
$4,561.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,990.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$346.05
|
| Rate for Payer: Zelis Auto |
$2,146.40
|
| Rate for Payer: Zelis Medicare |
$294.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$415.26
|
| Rate for Payer: Zelis Worker's Compensation |
$596.14
|
|
|
MRI LE NON-JNT W/O
|
Facility
|
IP
|
$3,946.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
2410105
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$402.61 |
| Max. Negotiated Rate |
$3,748.70 |
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cigna Commercial |
$3,354.10
|
| Rate for Payer: First Health Commercial |
$3,551.40
|
| Rate for Payer: First Health Workers Compensation |
$569.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,551.40
|
| Rate for Payer: GEHA Commercial |
$2,762.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,551.40
|
| Rate for Payer: Multiplan All |
$3,590.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,762.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,551.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,748.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,959.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,669.78
|
| Rate for Payer: Zelis Auto |
$1,578.40
|
| Rate for Payer: Zelis Worker's Compensation |
$402.61
|
|
|
MRI LE NON-JNT W/O
|
Facility
|
OP
|
$3,946.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
2410105
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$199.09 |
| Max. Negotiated Rate |
$3,748.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,367.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$234.22
|
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cigna Commercial |
$3,354.10
|
| Rate for Payer: First Health Commercial |
$3,551.40
|
| Rate for Payer: First Health Workers Compensation |
$569.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,551.40
|
| Rate for Payer: GEHA Commercial |
$3,156.80
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,551.40
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$3,590.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,762.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,551.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,748.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$2,959.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$3,354.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,669.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$1,578.40
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$402.61
|
|
|
MRI LE NON-JNT W/O RT
|
Facility
|
IP
|
$3,946.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
2002027
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$402.61 |
| Max. Negotiated Rate |
$3,748.70 |
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cigna Commercial |
$3,354.10
|
| Rate for Payer: First Health Commercial |
$3,551.40
|
| Rate for Payer: First Health Workers Compensation |
$569.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,551.40
|
| Rate for Payer: GEHA Commercial |
$2,762.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,551.40
|
| Rate for Payer: Multiplan All |
$3,590.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,762.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,551.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,748.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,959.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,669.78
|
| Rate for Payer: Zelis Auto |
$1,578.40
|
| Rate for Payer: Zelis Worker's Compensation |
$402.61
|
|
