|
MRI UE JNT W/O RT
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
2000183
|
|
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/WO
|
Facility
|
IP
|
$5,293.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
2410096
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$609.55 |
| Max. Negotiated Rate |
$5,028.35 |
| Rate for Payer: Cash Price |
$3,175.80
|
| Rate for Payer: Cash Price |
$3,175.80
|
| Rate for Payer: Cigna Commercial |
$4,499.05
|
| Rate for Payer: First Health Commercial |
$4,763.70
|
| Rate for Payer: First Health Workers Compensation |
$862.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,763.70
|
| Rate for Payer: GEHA Commercial |
$3,705.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,763.70
|
| Rate for Payer: Multiplan All |
$4,816.63
|
| Rate for Payer: OMNI Networks Commercial |
$3,705.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,763.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,028.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,969.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,922.49
|
| Rate for Payer: Zelis Auto |
$2,117.20
|
| Rate for Payer: Zelis Worker's Compensation |
$609.55
|
|
|
MRI UE JNT W/WO
|
Facility
|
OP
|
$5,293.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
2410096
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,028.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,175.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,175.80
|
| Rate for Payer: Cash Price |
$3,175.80
|
| Rate for Payer: Cigna Commercial |
$4,499.05
|
| Rate for Payer: First Health Commercial |
$4,763.70
|
| Rate for Payer: First Health Workers Compensation |
$862.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,763.70
|
| Rate for Payer: GEHA Commercial |
$4,234.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,763.70
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,816.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,705.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,763.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,028.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,969.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,499.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,922.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,117.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$609.55
|
|
|
MRI UE JNT W/WO RT
|
Facility
|
IP
|
$5,293.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
2002018
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$609.55 |
| Max. Negotiated Rate |
$5,028.35 |
| Rate for Payer: Cash Price |
$3,175.80
|
| Rate for Payer: Cash Price |
$3,175.80
|
| Rate for Payer: Cigna Commercial |
$4,499.05
|
| Rate for Payer: First Health Commercial |
$4,763.70
|
| Rate for Payer: First Health Workers Compensation |
$862.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,763.70
|
| Rate for Payer: GEHA Commercial |
$3,705.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,763.70
|
| Rate for Payer: Multiplan All |
$4,816.63
|
| Rate for Payer: OMNI Networks Commercial |
$3,705.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,763.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,028.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,969.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,922.49
|
| Rate for Payer: Zelis Auto |
$2,117.20
|
| Rate for Payer: Zelis Worker's Compensation |
$609.55
|
|
|
MRI UE JNT W/WO RT
|
Facility
|
OP
|
$5,293.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
2002018
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$5,028.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,175.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,175.80
|
| Rate for Payer: Cash Price |
$3,175.80
|
| Rate for Payer: Cigna Commercial |
$4,499.05
|
| Rate for Payer: First Health Commercial |
$4,763.70
|
| Rate for Payer: First Health Workers Compensation |
$862.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,763.70
|
| Rate for Payer: GEHA Commercial |
$4,234.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,763.70
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$649.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$4,816.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,705.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,763.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,028.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,969.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,499.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,922.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,117.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$609.55
|
|
|
MRI UE NON-JNT W/CON
|
Facility
|
IP
|
$3,801.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
2410093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$461.38 |
| Max. Negotiated Rate |
$3,610.95 |
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$3,230.85
|
| Rate for Payer: First Health Commercial |
$3,420.90
|
| Rate for Payer: First Health Workers Compensation |
$652.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,420.90
|
| Rate for Payer: GEHA Commercial |
$2,660.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,420.90
|
| Rate for Payer: Multiplan All |
$3,458.91
|
| Rate for Payer: OMNI Networks Commercial |
$2,660.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,420.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,610.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,850.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,534.93
|
| Rate for Payer: Zelis Auto |
$1,520.40
|
| Rate for Payer: Zelis Worker's Compensation |
$461.38
|
|
|
MRI UE NON-JNT W/CON
|
Facility
|
OP
|
$3,801.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
2410093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$3,610.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,280.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$3,230.85
|
| Rate for Payer: First Health Commercial |
$3,420.90
|
| Rate for Payer: First Health Workers Compensation |
$652.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,420.90
|
| Rate for Payer: GEHA Commercial |
$3,040.80
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,420.90
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$3,458.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,660.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,420.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,610.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,850.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$3,230.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,534.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,520.40
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$461.38
|
|
|
MRI UE NON-JNT W/CON RT
|
Facility
|
OP
|
$3,801.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
2002015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$3,610.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,280.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$3,230.85
|
| Rate for Payer: First Health Commercial |
$3,420.90
|
| Rate for Payer: First Health Workers Compensation |
$652.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,420.90
|
| Rate for Payer: GEHA Commercial |
$3,040.80
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,420.90
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$3,458.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,660.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,420.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,610.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,850.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$3,230.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,534.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,520.40
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$461.38
|
|
|
MRI UE NON-JNT W/CON RT
|
Facility
|
IP
|
$3,801.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
2002015
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$461.38 |
| Max. Negotiated Rate |
$3,610.95 |
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$3,230.85
|
| Rate for Payer: First Health Commercial |
$3,420.90
|
| Rate for Payer: First Health Workers Compensation |
$652.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,420.90
|
| Rate for Payer: GEHA Commercial |
$2,660.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,420.90
|
| Rate for Payer: Multiplan All |
$3,458.91
|
| Rate for Payer: OMNI Networks Commercial |
$2,660.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,420.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,610.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,850.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,534.93
|
| Rate for Payer: Zelis Auto |
$1,520.40
|
| Rate for Payer: Zelis Worker's Compensation |
$461.38
|
|
|
MRI UE NON-JNT W/O
|
Facility
|
IP
|
$3,857.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
2410092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$405.98 |
| Max. Negotiated Rate |
$3,664.15 |
| Rate for Payer: Cash Price |
$2,314.20
|
| Rate for Payer: Cash Price |
$2,314.20
|
| Rate for Payer: Cigna Commercial |
$3,278.45
|
| Rate for Payer: First Health Commercial |
$3,471.30
|
| Rate for Payer: First Health Workers Compensation |
$574.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,471.30
|
| Rate for Payer: GEHA Commercial |
$2,699.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,471.30
|
| Rate for Payer: Multiplan All |
$3,509.87
|
| Rate for Payer: OMNI Networks Commercial |
$2,699.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,471.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,664.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,892.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,587.01
|
| Rate for Payer: Zelis Auto |
$1,542.80
|
| Rate for Payer: Zelis Worker's Compensation |
$405.98
|
|
|
MRI UE NON-JNT W/O
|
Facility
|
OP
|
$3,857.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
2410092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,664.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,314.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,314.20
|
| Rate for Payer: Cash Price |
$2,314.20
|
| Rate for Payer: Cigna Commercial |
$3,278.45
|
| Rate for Payer: First Health Commercial |
$3,471.30
|
| Rate for Payer: First Health Workers Compensation |
$574.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,471.30
|
| Rate for Payer: GEHA Commercial |
$3,085.60
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,471.30
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,509.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,699.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,471.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,664.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,892.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,278.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,587.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,542.80
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$405.98
|
|
|
MRI UE NON-JNT W/O RT
|
Facility
|
IP
|
$3,857.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
2002014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$405.98 |
| Max. Negotiated Rate |
$3,664.15 |
| Rate for Payer: Cash Price |
$2,314.20
|
| Rate for Payer: Cash Price |
$2,314.20
|
| Rate for Payer: Cigna Commercial |
$3,278.45
|
| Rate for Payer: First Health Commercial |
$3,471.30
|
| Rate for Payer: First Health Workers Compensation |
$574.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,471.30
|
| Rate for Payer: GEHA Commercial |
$2,699.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,471.30
|
| Rate for Payer: Multiplan All |
$3,509.87
|
| Rate for Payer: OMNI Networks Commercial |
$2,699.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,471.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,664.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,892.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,587.01
|
| Rate for Payer: Zelis Auto |
$1,542.80
|
| Rate for Payer: Zelis Worker's Compensation |
$405.98
|
|
|
MRI UE NON-JNT W/O RT
|
Facility
|
OP
|
$3,857.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
2002014
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$3,664.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,314.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$524.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,314.20
|
| Rate for Payer: Cash Price |
$2,314.20
|
| Rate for Payer: Cigna Commercial |
$3,278.45
|
| Rate for Payer: First Health Commercial |
$3,471.30
|
| Rate for Payer: First Health Workers Compensation |
$574.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,471.30
|
| Rate for Payer: GEHA Commercial |
$3,085.60
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,471.30
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$423.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,509.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,699.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,471.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$489.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$423.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,664.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,892.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,278.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,587.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,542.80
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$405.98
|
|
|
MRI UE NON-JNT W/WO
|
Facility
|
IP
|
$5,040.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
2002029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$559.98 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cigna Commercial |
$4,284.00
|
| Rate for Payer: First Health Commercial |
$4,536.00
|
| Rate for Payer: First Health Workers Compensation |
$791.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,536.00
|
| Rate for Payer: GEHA Commercial |
$3,528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,536.00
|
| Rate for Payer: Multiplan All |
$4,586.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,528.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,536.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,788.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,780.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,687.20
|
| Rate for Payer: Zelis Auto |
$2,016.00
|
| Rate for Payer: Zelis Worker's Compensation |
$559.98
|
|
|
MRI UE NON-JNT W/WO
|
Facility
|
OP
|
$5,040.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
2002029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,024.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cigna Commercial |
$4,284.00
|
| Rate for Payer: First Health Commercial |
$4,536.00
|
| Rate for Payer: First Health Workers Compensation |
$791.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,536.00
|
| Rate for Payer: GEHA Commercial |
$4,032.00
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,536.00
|
| 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 |
$4,586.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,528.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,536.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,788.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,780.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,284.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,687.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,016.00
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$559.98
|
|
|
MRI UE NON-JNT W/WO RT
|
Facility
|
OP
|
$5,040.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
2002030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,024.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$803.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$636.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cigna Commercial |
$4,284.00
|
| Rate for Payer: First Health Commercial |
$4,536.00
|
| Rate for Payer: First Health Workers Compensation |
$791.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,536.00
|
| Rate for Payer: GEHA Commercial |
$4,032.00
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,536.00
|
| 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 |
$4,586.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$3,528.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,536.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$749.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$649.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,788.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,780.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$4,284.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,687.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,016.00
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$559.98
|
|
|
MRI UE NON-JNT W/WO RT
|
Facility
|
IP
|
$5,040.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
2002030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$559.98 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cigna Commercial |
$4,284.00
|
| Rate for Payer: First Health Commercial |
$4,536.00
|
| Rate for Payer: First Health Workers Compensation |
$791.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,536.00
|
| Rate for Payer: GEHA Commercial |
$3,528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,536.00
|
| Rate for Payer: Multiplan All |
$4,586.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,528.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,536.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,788.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,780.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,687.20
|
| Rate for Payer: Zelis Auto |
$2,016.00
|
| Rate for Payer: Zelis Worker's Compensation |
$559.98
|
|
|
M/S ADDL VACCINE ADMINISTRATION
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
1000013
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$17.00
|
| Rate for Payer: First Health Commercial |
$18.00
|
| Rate for Payer: First Health Workers Compensation |
$7.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.00
|
| Rate for Payer: GEHA Commercial |
$14.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.00
|
| Rate for Payer: Multiplan All |
$18.20
|
| Rate for Payer: OMNI Networks Commercial |
$14.00
|
| Rate for Payer: One Health Plan PPO/POS |
$18.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.00
|
| Rate for Payer: Three Rivers Provider Network All |
$15.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18.60
|
| Rate for Payer: Zelis Auto |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$5.46
|
|
|
M/S ADDL VACCINE ADMINISTRATION
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
1000013
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$17.00
|
| Rate for Payer: First Health Commercial |
$18.00
|
| Rate for Payer: First Health Workers Compensation |
$7.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.00
|
| Rate for Payer: GEHA Commercial |
$16.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.00
|
| Rate for Payer: Humana ChoiceCare |
$5.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Multiplan All |
$18.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.00
|
| Rate for Payer: OMNI Networks Commercial |
$14.00
|
| Rate for Payer: One Health Plan PPO/POS |
$18.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.00
|
| Rate for Payer: Three Rivers Provider Network All |
$15.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18.60
|
| Rate for Payer: Zelis Auto |
$8.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$5.46
|
|
|
M/S ADMIN INFLUENZA VACCINE
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1000014
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$35.76 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$50.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$35.76
|
|
|
M/S ADMIN PNEUMONIA VACCINE
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1000015
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$35.76 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$50.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$35.76
|
|
|
M/S CONCURRENT DRUG INFUSION
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
1000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$158.89 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$494.70
|
| Rate for Payer: First Health Commercial |
$523.80
|
| Rate for Payer: First Health Workers Compensation |
$224.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$523.80
|
| Rate for Payer: GEHA Commercial |
$407.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$523.80
|
| Rate for Payer: Multiplan All |
$529.62
|
| Rate for Payer: OMNI Networks Commercial |
$407.40
|
| Rate for Payer: One Health Plan PPO/POS |
$523.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$552.90
|
| Rate for Payer: Three Rivers Provider Network All |
$436.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$541.26
|
| Rate for Payer: Zelis Auto |
$232.80
|
| Rate for Payer: Zelis Worker's Compensation |
$158.89
|
|
|
MS-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$19,040.95
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$2,276.05 |
| Max. Negotiated Rate |
$19,040.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,276.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,715.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,276.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,279.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11,200.56
|
| Rate for Payer: GEHA Medicare |
$11,200.56
|
| Rate for Payer: Humana ChoiceCare |
$12,320.62
|
| Rate for Payer: Humana Medicare Advantage |
$11,200.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$18,816.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,279.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11,200.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19,040.95
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15,680.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,279.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11,200.56
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16,016.80
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,976.55
|
| Rate for Payer: United Healthcare Commercial |
$7,338.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,279.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,200.56
|
| Rate for Payer: Zelis Medicare |
$9,520.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,047.80
|
|
|
MS-DRG 42.00: ABORTION WITHOUT D&C
|
Facility
|
IP
|
$16,654.13
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$1,720.95 |
| Max. Negotiated Rate |
$16,654.13 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,720.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,571.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,720.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,299.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,796.55
|
| Rate for Payer: GEHA Medicare |
$9,796.55
|
| Rate for Payer: Humana ChoiceCare |
$10,776.20
|
| Rate for Payer: Humana Medicare Advantage |
$9,796.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,458.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,299.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,796.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,654.13
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13,715.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,299.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,796.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14,009.07
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,600.62
|
| Rate for Payer: United Healthcare Commercial |
$6,375.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,299.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,796.55
|
| Rate for Payer: Zelis Medicare |
$8,327.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,122.94
|
|
|
MS-DRG 42.00: ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$17,001.80
|
|
|
Service Code
|
MSDRG 880
|
| Min. Negotiated Rate |
$2,778.65 |
| Max. Negotiated Rate |
$17,001.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,778.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,764.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,778.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,166.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10,001.06
|
| Rate for Payer: GEHA Medicare |
$10,001.06
|
| Rate for Payer: Humana ChoiceCare |
$11,001.17
|
| Rate for Payer: Humana Medicare Advantage |
$10,001.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,801.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,166.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10,001.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17,001.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14,001.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,166.91
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10,001.06
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14,301.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,801.04
|
| Rate for Payer: United Healthcare Commercial |
$6,537.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,166.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,001.06
|
| Rate for Payer: Zelis Medicare |
$8,500.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,278.83
|
|
