117 CAMINO DE VIDA SUITE 100, SANTA ROSA, NM, 320067
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| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 0 | $228 | $182.4 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $387 | $309.6 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $786 | $628.8 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,338 | $1,070.4 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $2,134 | $1,707.2 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,826 | $1,460.8 | — | — | — |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 0 | $1,278 | $1,022.4 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,319 | $1,055.2 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $1,785 | $1,428 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,688 | $1,350.4 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $137 | $109.6 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $190 | $152 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,550 | $1,240 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,860 | $1,488 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,299 | $1,839.2 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $214 | $171.2 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,610 | $1,288 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,618 | $1,294.4 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,643 | $1,314.4 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,529 | $1,223.2 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,733 | $1,386.4 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $306 | $244.8 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $188 | $150.4 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $208 | $166.4 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $179 | $143.2 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $214 | $171.2 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,696 | $1,356.8 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,131 | $1,704.8 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,553 | $2,042.4 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $1,861 | $1,488.8 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $2,761 | $2,208.8 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $3,041 | $2,432.8 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $149 | $119.2 | — | — | — |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $98 | $78.4 | — | — | — |
| General health panel | CPT | 80050 | 0 | $431 | $344.8 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $81 | $64.8 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $133 | $106.4 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $175 | $140 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $102 | $81.6 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $106 | $84.8 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $32 | $25.6 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $33 | $26.4 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $42 | $33.6 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $132 | $105.6 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $203 | $162.4 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $71 | $56.8 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $95 | $76 | — | — | — |
| maternity | ||||||||
| Vaginal delivery only | CPT | 59409 | 0 | $5,136 | $4,108.8 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $5,983 | $4,786.4 | — | — | — |
