|
MRI PELVIS W/WO
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
2002026
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,175.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,268.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cigna Commercial |
$4,630.80
|
| Rate for Payer: First Health Commercial |
$4,903.20
|
| Rate for Payer: First Health Workers Compensation |
$877.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,903.20
|
| Rate for Payer: GEHA Commercial |
$4,358.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,903.20
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,957.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,813.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,903.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,175.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,086.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,630.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,066.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,179.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$620.58
|
|
|
MRI PELVIS W/WO
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
2002026
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$620.58 |
| Max. Negotiated Rate |
$5,175.60 |
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cigna Commercial |
$4,630.80
|
| Rate for Payer: First Health Commercial |
$4,903.20
|
| Rate for Payer: First Health Workers Compensation |
$877.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,903.20
|
| Rate for Payer: GEHA Commercial |
$3,813.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,903.20
|
| Rate for Payer: Multiplan All |
$4,957.68
|
| Rate for Payer: OMNI Networks Commercial |
$3,813.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,903.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,175.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,086.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,066.64
|
| Rate for Payer: Zelis Auto |
$2,179.20
|
| Rate for Payer: Zelis Worker's Compensation |
$620.58
|
|
|
MRI PITUITARY W/WO
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
2070553
|
|
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 PITUITARY W/WO
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
2070553
|
|
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 POST PROCESSING MIP/3D
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
2076376
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$92.08 |
| Max. Negotiated Rate |
$942.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$595.20
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cigna Commercial |
$843.20
|
| Rate for Payer: First Health Commercial |
$892.80
|
| Rate for Payer: First Health Workers Compensation |
$130.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$892.80
|
| Rate for Payer: GEHA Commercial |
$793.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$892.80
|
| Rate for Payer: Humana ChoiceCare |
$257.92
|
| Rate for Payer: Multiplan All |
$902.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$595.20
|
| Rate for Payer: OMNI Networks Commercial |
$694.40
|
| Rate for Payer: One Health Plan PPO/POS |
$892.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$942.40
|
| Rate for Payer: Three Rivers Provider Network All |
$744.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.96
|
| Rate for Payer: United Healthcare Commercial |
$843.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$248.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$922.56
|
| Rate for Payer: Zelis Auto |
$396.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$496.00
|
| Rate for Payer: Zelis Worker's Compensation |
$92.08
|
|
|
MRI POST PROCESSING MIP/3D
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
2076376
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$92.08 |
| Max. Negotiated Rate |
$942.40 |
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cigna Commercial |
$843.20
|
| Rate for Payer: First Health Commercial |
$892.80
|
| Rate for Payer: First Health Workers Compensation |
$130.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$892.80
|
| Rate for Payer: GEHA Commercial |
$694.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$892.80
|
| Rate for Payer: Multiplan All |
$902.72
|
| Rate for Payer: OMNI Networks Commercial |
$694.40
|
| Rate for Payer: One Health Plan PPO/POS |
$892.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$942.40
|
| Rate for Payer: Three Rivers Provider Network All |
$744.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$922.56
|
| Rate for Payer: Zelis Auto |
$396.80
|
| Rate for Payer: Zelis Worker's Compensation |
$92.08
|
|
|
MRI PROSTATE W/WO CONTRAST
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
2672197
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,175.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,268.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cigna Commercial |
$4,630.80
|
| Rate for Payer: First Health Commercial |
$4,903.20
|
| Rate for Payer: First Health Workers Compensation |
$877.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,903.20
|
| Rate for Payer: GEHA Commercial |
$4,358.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,903.20
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,957.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,813.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,903.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,175.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,086.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,630.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,066.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,179.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$620.58
|
|
|
MRI PROSTATE W/WO CONTRAST
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
2672197
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$620.58 |
| Max. Negotiated Rate |
$5,175.60 |
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cigna Commercial |
$4,630.80
|
| Rate for Payer: First Health Commercial |
$4,903.20
|
| Rate for Payer: First Health Workers Compensation |
$877.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,903.20
|
| Rate for Payer: GEHA Commercial |
$3,813.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,903.20
|
| Rate for Payer: Multiplan All |
$4,957.68
|
| Rate for Payer: OMNI Networks Commercial |
$3,813.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,903.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,175.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,086.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,066.64
|
| Rate for Payer: Zelis Auto |
$2,179.20
|
| Rate for Payer: Zelis Worker's Compensation |
$620.58
|
|
|
MRI SCROTUM W/WO
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
2400130
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,175.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,268.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cigna Commercial |
$4,630.80
|
| Rate for Payer: First Health Commercial |
$4,903.20
|
| Rate for Payer: First Health Workers Compensation |
$877.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,903.20
|
| Rate for Payer: GEHA Commercial |
$4,358.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,903.20
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,957.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,813.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,903.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,175.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,086.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,630.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,066.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,179.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$620.58
|
|
|
MRI SCROTUM W/WO
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
2400130
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$620.58 |
| Max. Negotiated Rate |
$5,175.60 |
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cash Price |
$3,268.80
|
| Rate for Payer: Cigna Commercial |
$4,630.80
|
| Rate for Payer: First Health Commercial |
$4,903.20
|
| Rate for Payer: First Health Workers Compensation |
$877.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,903.20
|
| Rate for Payer: GEHA Commercial |
$3,813.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,903.20
|
| Rate for Payer: Multiplan All |
$4,957.68
|
| Rate for Payer: OMNI Networks Commercial |
$3,813.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,903.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,175.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,086.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,066.64
|
| Rate for Payer: Zelis Auto |
$2,179.20
|
| Rate for Payer: Zelis Worker's Compensation |
$620.58
|
|
|
MRI TEMPEROMANDIBULAR JOINT
|
Facility
|
IP
|
$3,596.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
2000182
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$390.43 |
| Max. Negotiated Rate |
$3,416.20 |
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cigna Commercial |
$3,056.60
|
| Rate for Payer: First Health Commercial |
$3,236.40
|
| Rate for Payer: First Health Workers Compensation |
$552.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,236.40
|
| Rate for Payer: GEHA Commercial |
$2,517.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,236.40
|
| Rate for Payer: Multiplan All |
$3,272.36
|
| Rate for Payer: OMNI Networks Commercial |
$2,517.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,236.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,416.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,697.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,344.28
|
| Rate for Payer: Zelis Auto |
$1,438.40
|
| Rate for Payer: Zelis Worker's Compensation |
$390.43
|
|
|
MRI TEMPEROMANDIBULAR JOINT
|
Facility
|
OP
|
$3,596.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
2000182
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,416.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,157.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cigna Commercial |
$3,056.60
|
| Rate for Payer: First Health Commercial |
$3,236.40
|
| Rate for Payer: First Health Workers Compensation |
$552.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,236.40
|
| Rate for Payer: GEHA Commercial |
$2,876.80
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,236.40
|
| 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 |
$3,272.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,517.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,236.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,416.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,697.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,056.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,344.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,438.40
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$390.43
|
|
|
MRI T-SPINE W/CON
|
Facility
|
OP
|
$4,548.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
2000181
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$4,320.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,728.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cigna Commercial |
$3,865.80
|
| Rate for Payer: First Health Commercial |
$4,093.20
|
| Rate for Payer: First Health Workers Compensation |
$661.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,093.20
|
| Rate for Payer: GEHA Commercial |
$3,638.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,093.20
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,138.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,183.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,093.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,320.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,411.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$3,865.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,229.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,819.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$467.80
|
|
|
MRI T-SPINE W/CON
|
Facility
|
IP
|
$4,548.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
2000181
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$467.80 |
| Max. Negotiated Rate |
$4,320.60 |
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cigna Commercial |
$3,865.80
|
| Rate for Payer: First Health Commercial |
$4,093.20
|
| Rate for Payer: First Health Workers Compensation |
$661.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,093.20
|
| Rate for Payer: GEHA Commercial |
$3,183.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,093.20
|
| Rate for Payer: Multiplan All |
$4,138.68
|
| Rate for Payer: OMNI Networks Commercial |
$3,183.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,093.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,320.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,411.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,229.64
|
| Rate for Payer: Zelis Auto |
$1,819.20
|
| Rate for Payer: Zelis Worker's Compensation |
$467.80
|
|
|
MRI T-SPINE W/O
|
Facility
|
OP
|
$4,105.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
2000179
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,899.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,463.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cigna Commercial |
$3,489.25
|
| Rate for Payer: First Health Commercial |
$3,694.50
|
| Rate for Payer: First Health Workers Compensation |
$578.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,694.50
|
| Rate for Payer: GEHA Commercial |
$3,284.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,694.50
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,735.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,873.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,694.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,899.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,078.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,489.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,817.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,642.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$408.74
|
|
|
MRI T-SPINE W/O
|
Facility
|
IP
|
$4,105.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
2000179
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$408.74 |
| Max. Negotiated Rate |
$3,899.75 |
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cigna Commercial |
$3,489.25
|
| Rate for Payer: First Health Commercial |
$3,694.50
|
| Rate for Payer: First Health Workers Compensation |
$578.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,694.50
|
| Rate for Payer: GEHA Commercial |
$2,873.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,694.50
|
| Rate for Payer: Multiplan All |
$3,735.55
|
| Rate for Payer: OMNI Networks Commercial |
$2,873.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,694.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,899.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,078.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,817.65
|
| Rate for Payer: Zelis Auto |
$1,642.00
|
| Rate for Payer: Zelis Worker's Compensation |
$408.74
|
|
|
MRI T-SPINE W/WO
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
2000180
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$570.51 |
| Max. Negotiated Rate |
$5,435.90 |
| Rate for Payer: Cash Price |
$3,433.20
|
| Rate for Payer: Cash Price |
$3,433.20
|
| Rate for Payer: Cigna Commercial |
$4,863.70
|
| Rate for Payer: First Health Commercial |
$5,149.80
|
| Rate for Payer: First Health Workers Compensation |
$806.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,149.80
|
| Rate for Payer: GEHA Commercial |
$4,005.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,149.80
|
| Rate for Payer: Multiplan All |
$5,207.02
|
| Rate for Payer: OMNI Networks Commercial |
$4,005.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,149.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,435.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,291.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,321.46
|
| Rate for Payer: Zelis Auto |
$2,288.80
|
| Rate for Payer: Zelis Worker's Compensation |
$570.51
|
|
|
MRI T-SPINE W/WO
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
2000180
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,435.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,433.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,433.20
|
| Rate for Payer: Cash Price |
$3,433.20
|
| Rate for Payer: Cigna Commercial |
$4,863.70
|
| Rate for Payer: First Health Commercial |
$5,149.80
|
| Rate for Payer: First Health Workers Compensation |
$806.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,149.80
|
| Rate for Payer: GEHA Commercial |
$4,577.60
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,149.80
|
| 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 |
$5,207.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,005.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,149.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,435.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,291.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,863.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,321.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,288.80
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$570.51
|
|
|
MRI UE JNT W/CON
|
Facility
|
OP
|
$4,277.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
2410095
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$452.71 |
| Max. Negotiated Rate |
$4,063.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,566.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$750.19
|
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Cigna Commercial |
$3,635.45
|
| Rate for Payer: First Health Commercial |
$3,849.30
|
| Rate for Payer: First Health Workers Compensation |
$640.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,849.30
|
| Rate for Payer: GEHA Commercial |
$3,421.60
|
| Rate for Payer: GEHA Medicare |
$750.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,849.30
|
| 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 |
$3,892.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,275.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,993.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,849.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$750.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,063.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,500.38
|
| Rate for Payer: Three Rivers Provider Network All |
$3,207.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$735.19
|
| Rate for Payer: United Healthcare Commercial |
$3,635.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,977.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$750.19
|
| Rate for Payer: Zelis Auto |
$1,710.80
|
| Rate for Payer: Zelis Medicare |
$637.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$900.23
|
| Rate for Payer: Zelis Worker's Compensation |
$452.71
|
|
|
MRI UE JNT W/CON
|
Facility
|
IP
|
$4,277.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
2410095
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$452.71 |
| Max. Negotiated Rate |
$4,063.15 |
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Cigna Commercial |
$3,635.45
|
| Rate for Payer: First Health Commercial |
$3,849.30
|
| Rate for Payer: First Health Workers Compensation |
$640.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,849.30
|
| Rate for Payer: GEHA Commercial |
$2,993.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,849.30
|
| Rate for Payer: Multiplan All |
$3,892.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,993.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,849.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,063.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,207.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,977.61
|
| Rate for Payer: Zelis Auto |
$1,710.80
|
| Rate for Payer: Zelis Worker's Compensation |
$452.71
|
|
|
MRI UE JNT W/CON RT
|
Facility
|
OP
|
$4,277.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
2000190
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$452.71 |
| Max. Negotiated Rate |
$4,063.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,566.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$750.19
|
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Cigna Commercial |
$3,635.45
|
| Rate for Payer: First Health Commercial |
$3,849.30
|
| Rate for Payer: First Health Workers Compensation |
$640.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,849.30
|
| Rate for Payer: GEHA Commercial |
$3,421.60
|
| Rate for Payer: GEHA Medicare |
$750.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,849.30
|
| 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 |
$3,892.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,275.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,993.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,849.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$750.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,063.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,500.38
|
| Rate for Payer: Three Rivers Provider Network All |
$3,207.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$735.19
|
| Rate for Payer: United Healthcare Commercial |
$3,635.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,977.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$750.19
|
| Rate for Payer: Zelis Auto |
$1,710.80
|
| Rate for Payer: Zelis Medicare |
$637.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$900.23
|
| Rate for Payer: Zelis Worker's Compensation |
$452.71
|
|
|
MRI UE JNT W/CON RT
|
Facility
|
IP
|
$4,277.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
2000190
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$452.71 |
| Max. Negotiated Rate |
$4,063.15 |
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Cigna Commercial |
$3,635.45
|
| Rate for Payer: First Health Commercial |
$3,849.30
|
| Rate for Payer: First Health Workers Compensation |
$640.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,849.30
|
| Rate for Payer: GEHA Commercial |
$2,993.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,849.30
|
| Rate for Payer: Multiplan All |
$3,892.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,993.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,849.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,063.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,207.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,977.61
|
| Rate for Payer: Zelis Auto |
$1,710.80
|
| Rate for Payer: Zelis Worker's Compensation |
$452.71
|
|
|
MRI UE JNT W/O
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
2410094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$407.01 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cigna Commercial |
$3,400.00
|
| Rate for Payer: First Health Commercial |
$3,600.00
|
| Rate for Payer: First Health Workers Compensation |
$575.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,600.00
|
| Rate for Payer: GEHA Commercial |
$2,800.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,600.00
|
| Rate for Payer: Multiplan All |
$3,640.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,800.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,600.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,800.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,000.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,720.00
|
| Rate for Payer: Zelis Auto |
$1,600.00
|
| Rate for Payer: Zelis Worker's Compensation |
$407.01
|
|
|
MRI UE JNT W/O
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
2410094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cigna Commercial |
$3,400.00
|
| Rate for Payer: First Health Commercial |
$3,600.00
|
| Rate for Payer: First Health Workers Compensation |
$575.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,600.00
|
| Rate for Payer: GEHA Commercial |
$3,200.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,600.00
|
| 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 |
$3,640.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,800.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,600.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,800.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,000.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,400.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,720.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,600.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$407.01
|
|
|
MRI UE JNT W/O RT
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
2000183
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cigna Commercial |
$3,400.00
|
| Rate for Payer: First Health Commercial |
$3,600.00
|
| Rate for Payer: First Health Workers Compensation |
$575.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,600.00
|
| Rate for Payer: GEHA Commercial |
$3,200.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,600.00
|
| 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 |
$3,640.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,800.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,600.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,800.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$3,000.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,400.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,720.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,600.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$407.01
|
|
