|
UREA NITROGEN RAND URINE WO CREAT REF
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
2300113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.56
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$9.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$5.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$6.12
|
| Rate for Payer: Humana Medicare Advantage |
$5.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.56
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.45
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.12
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.45
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.56
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$4.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.67
|
| Rate for Payer: Zelis Worker's Compensation |
$6.77
|
|
|
UREA NITROGEN RAND URINE WO CREAT REF
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
22000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.56
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$9.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$5.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$6.12
|
| Rate for Payer: Humana Medicare Advantage |
$5.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.56
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.45
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.12
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.45
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.56
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$4.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.67
|
| Rate for Payer: Zelis Worker's Compensation |
$6.77
|
|
|
UREA NITROGEN RAND URINE WO CREAT REF
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
22000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$9.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.77
|
|
|
UREA NITROGEN RAND URINE WO CREAT REF
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
2300113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$9.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.77
|
|
|
URETER ENDOSCOPY
|
Facility
|
OP
|
$966.00
|
|
|
Service Code
|
CPT 50970
|
| Hospital Charge Code |
6150970
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.72 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$579.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$571.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$821.10
|
| Rate for Payer: First Health Commercial |
$869.40
|
| Rate for Payer: First Health Workers Compensation |
$372.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$869.40
|
| Rate for Payer: GEHA Commercial |
$772.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$583.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$879.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$676.20
|
| Rate for Payer: One Health Plan PPO/POS |
$869.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$673.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$583.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$917.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$724.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$898.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$386.40
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$263.72
|
|
|
URETER ENDOSCOPY
|
Facility
|
IP
|
$966.00
|
|
|
Service Code
|
CPT 50970
|
| Hospital Charge Code |
6150970
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.72 |
| Max. Negotiated Rate |
$917.70 |
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$821.10
|
| Rate for Payer: First Health Commercial |
$869.40
|
| Rate for Payer: First Health Workers Compensation |
$372.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$869.40
|
| Rate for Payer: GEHA Commercial |
$676.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$869.40
|
| Rate for Payer: Multiplan All |
$879.06
|
| Rate for Payer: OMNI Networks Commercial |
$676.20
|
| Rate for Payer: One Health Plan PPO/POS |
$869.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$917.70
|
| Rate for Payer: Three Rivers Provider Network All |
$724.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$898.38
|
| Rate for Payer: Zelis Auto |
$386.40
|
| Rate for Payer: Zelis Worker's Compensation |
$263.72
|
|
|
URETER ENDOSCOPY & BIOPSY
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
CPT 50955
|
| Hospital Charge Code |
6150955
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$249.79 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$549.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna Commercial |
$777.75
|
| Rate for Payer: First Health Commercial |
$823.50
|
| Rate for Payer: First Health Workers Compensation |
$353.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$823.50
|
| Rate for Payer: GEHA Commercial |
$732.00
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$823.50
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$832.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$640.50
|
| Rate for Payer: One Health Plan PPO/POS |
$823.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$869.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$686.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$366.00
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$249.79
|
|
|
URETER ENDOSCOPY & BIOPSY
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 50974
|
| Hospital Charge Code |
6150974
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$268.63 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,722.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$590.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,722.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,364.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$836.40
|
| Rate for Payer: First Health Commercial |
$885.60
|
| Rate for Payer: First Health Workers Compensation |
$379.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$885.60
|
| Rate for Payer: GEHA Commercial |
$787.20
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$885.60
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$895.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$688.80
|
| Rate for Payer: One Health Plan PPO/POS |
$885.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,607.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$934.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$738.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$915.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$393.60
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$268.63
|
|
|
URETER ENDOSCOPY & BIOPSY
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 50974
|
| Hospital Charge Code |
6150974
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$268.63 |
| Max. Negotiated Rate |
$934.80 |
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$836.40
|
| Rate for Payer: First Health Commercial |
$885.60
|
| Rate for Payer: First Health Workers Compensation |
$379.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$885.60
|
| Rate for Payer: GEHA Commercial |
$688.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$885.60
|
| Rate for Payer: Multiplan All |
$895.44
|
| Rate for Payer: OMNI Networks Commercial |
$688.80
|
| Rate for Payer: One Health Plan PPO/POS |
$885.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$934.80
|
| Rate for Payer: Three Rivers Provider Network All |
$738.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$915.12
|
| Rate for Payer: Zelis Auto |
$393.60
|
| Rate for Payer: Zelis Worker's Compensation |
$268.63
|
|
|
URETER ENDOSCOPY & BIOPSY
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
CPT 50955
|
| Hospital Charge Code |
6150955
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$249.79 |
| Max. Negotiated Rate |
$869.25 |
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna Commercial |
$777.75
|
| Rate for Payer: First Health Commercial |
$823.50
|
| Rate for Payer: First Health Workers Compensation |
$353.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$823.50
|
| Rate for Payer: GEHA Commercial |
$640.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$823.50
|
| Rate for Payer: Multiplan All |
$832.65
|
| Rate for Payer: OMNI Networks Commercial |
$640.50
|
| Rate for Payer: One Health Plan PPO/POS |
$823.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$869.25
|
| Rate for Payer: Three Rivers Provider Network All |
$686.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.95
|
| Rate for Payer: Zelis Auto |
$366.00
|
| Rate for Payer: Zelis Worker's Compensation |
$249.79
|
|
|
URETER ENDOSCOPY & CATHETER
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 50972
|
| Hospital Charge Code |
6150972
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$894.90 |
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$800.70
|
| Rate for Payer: First Health Commercial |
$847.80
|
| Rate for Payer: First Health Workers Compensation |
$363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$847.80
|
| Rate for Payer: GEHA Commercial |
$659.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$847.80
|
| Rate for Payer: Multiplan All |
$857.22
|
| Rate for Payer: OMNI Networks Commercial |
$659.40
|
| Rate for Payer: One Health Plan PPO/POS |
$847.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$894.90
|
| Rate for Payer: Three Rivers Provider Network All |
$706.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.06
|
| Rate for Payer: Zelis Auto |
$376.80
|
| Rate for Payer: Zelis Worker's Compensation |
$257.17
|
|
|
URETER ENDOSCOPY & CATHETER
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 50972
|
| Hospital Charge Code |
6150972
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$565.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$571.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$800.70
|
| Rate for Payer: First Health Commercial |
$847.80
|
| Rate for Payer: First Health Workers Compensation |
$363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$847.80
|
| Rate for Payer: GEHA Commercial |
$753.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$847.80
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$583.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$857.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$659.40
|
| Rate for Payer: One Health Plan PPO/POS |
$847.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$673.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$583.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$894.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$706.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$376.80
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$257.17
|
|
|
URETER ENDOSCOPY & TREATMENT
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
CPT 50980
|
| Hospital Charge Code |
6150980
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$782.00
|
| Rate for Payer: First Health Commercial |
$828.00
|
| Rate for Payer: First Health Workers Compensation |
$355.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$828.00
|
| Rate for Payer: GEHA Commercial |
$644.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$828.00
|
| Rate for Payer: Multiplan All |
$837.20
|
| Rate for Payer: OMNI Networks Commercial |
$644.00
|
| Rate for Payer: One Health Plan PPO/POS |
$828.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$874.00
|
| Rate for Payer: Three Rivers Provider Network All |
$690.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$855.60
|
| Rate for Payer: Zelis Auto |
$368.00
|
| Rate for Payer: Zelis Worker's Compensation |
$251.16
|
|
|
URETER ENDOSCOPY & TREATMENT
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 50976
|
| Hospital Charge Code |
6150976
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$918.65 |
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$821.95
|
| Rate for Payer: First Health Commercial |
$870.30
|
| Rate for Payer: First Health Workers Compensation |
$373.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$870.30
|
| Rate for Payer: GEHA Commercial |
$676.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Worker's Compensation |
$263.99
|
|
|
URETER ENDOSCOPY & TREATMENT
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
CPT 50957
|
| Hospital Charge Code |
6150957
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.43 |
| Max. Negotiated Rate |
$874.95 |
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Cigna Commercial |
$782.85
|
| Rate for Payer: First Health Commercial |
$828.90
|
| Rate for Payer: First Health Workers Compensation |
$355.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$828.90
|
| Rate for Payer: GEHA Commercial |
$644.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$828.90
|
| Rate for Payer: Multiplan All |
$838.11
|
| Rate for Payer: OMNI Networks Commercial |
$644.70
|
| Rate for Payer: One Health Plan PPO/POS |
$828.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$874.95
|
| Rate for Payer: Three Rivers Provider Network All |
$690.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$856.53
|
| Rate for Payer: Zelis Auto |
$368.40
|
| Rate for Payer: Zelis Worker's Compensation |
$251.43
|
|
|
URETER ENDOSCOPY & TREATMENT
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
6150961
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
URETER ENDOSCOPY & TREATMENT
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
CPT 50980
|
| Hospital Charge Code |
6150980
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$552.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$782.00
|
| Rate for Payer: First Health Commercial |
$828.00
|
| Rate for Payer: First Health Workers Compensation |
$355.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$828.00
|
| Rate for Payer: GEHA Commercial |
$736.00
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$828.00
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$837.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$644.00
|
| Rate for Payer: One Health Plan PPO/POS |
$828.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$874.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$690.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$855.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$368.00
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$251.16
|
|
|
URETER ENDOSCOPY & TREATMENT
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 50976
|
| Hospital Charge Code |
6150976
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,722.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$580.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,722.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,364.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$821.95
|
| Rate for Payer: First Health Commercial |
$870.30
|
| Rate for Payer: First Health Workers Compensation |
$373.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$870.30
|
| Rate for Payer: GEHA Commercial |
$773.60
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,607.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$263.99
|
|
|
URETER ENDOSCOPY & TREATMENT
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
6150961
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
URETER ENDOSCOPY & TREATMENT
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
CPT 50957
|
| Hospital Charge Code |
6150957
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.43 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$552.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Cigna Commercial |
$782.85
|
| Rate for Payer: First Health Commercial |
$828.90
|
| Rate for Payer: First Health Workers Compensation |
$355.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$828.90
|
| Rate for Payer: GEHA Commercial |
$736.80
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$828.90
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$838.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$644.70
|
| Rate for Payer: One Health Plan PPO/POS |
$828.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$874.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$690.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$856.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$368.40
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$251.43
|
|
|
URETHRLYS TRANSVAG W/ SCOPE
|
Facility
|
IP
|
$1,539.00
|
|
|
Service Code
|
CPT 53500
|
| Hospital Charge Code |
6153500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$420.15 |
| Max. Negotiated Rate |
$1,462.05 |
| Rate for Payer: Cash Price |
$923.40
|
| Rate for Payer: Cigna Commercial |
$1,308.15
|
| Rate for Payer: First Health Commercial |
$1,385.10
|
| Rate for Payer: First Health Workers Compensation |
$594.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,385.10
|
| Rate for Payer: GEHA Commercial |
$1,077.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,385.10
|
| Rate for Payer: Multiplan All |
$1,400.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,077.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,385.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,462.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,154.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,431.27
|
| Rate for Payer: Zelis Auto |
$615.60
|
| Rate for Payer: Zelis Worker's Compensation |
$420.15
|
|
|
URETHRLYS TRANSVAG W/ SCOPE
|
Facility
|
OP
|
$1,539.00
|
|
|
Service Code
|
CPT 53500
|
| Hospital Charge Code |
6153500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$420.15 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$923.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,513.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$923.40
|
| Rate for Payer: Cash Price |
$923.40
|
| Rate for Payer: Cigna Commercial |
$1,308.15
|
| Rate for Payer: First Health Commercial |
$1,385.10
|
| Rate for Payer: First Health Workers Compensation |
$594.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,385.10
|
| Rate for Payer: GEHA Commercial |
$1,231.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,385.10
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,400.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,077.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,385.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,961.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,564.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,462.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,154.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,431.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$615.60
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$420.15
|
|
|
uric acid 24hr urine REF003418
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
2204557
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.08
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$68.00
|
| Rate for Payer: First Health Commercial |
$72.00
|
| Rate for Payer: First Health Workers Compensation |
$8.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.00
|
| Rate for Payer: GEHA Commercial |
$64.00
|
| Rate for Payer: GEHA Medicare |
$5.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.00
|
| Rate for Payer: Humana ChoiceCare |
$5.59
|
| Rate for Payer: Humana Medicare Advantage |
$5.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.08
|
| Rate for Payer: Multiplan All |
$72.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.64
|
| Rate for Payer: OMNI Networks Commercial |
$56.00
|
| Rate for Payer: One Health Plan PPO/POS |
$72.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.16
|
| Rate for Payer: Three Rivers Provider Network All |
$60.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.98
|
| Rate for Payer: United Healthcare Commercial |
$68.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$74.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.08
|
| Rate for Payer: Zelis Auto |
$32.00
|
| Rate for Payer: Zelis Medicare |
$4.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.10
|
| Rate for Payer: Zelis Worker's Compensation |
$6.05
|
|
|
uric acid 24hr urine REF003418
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
2204557
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$68.00
|
| Rate for Payer: First Health Commercial |
$72.00
|
| Rate for Payer: First Health Workers Compensation |
$8.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.00
|
| Rate for Payer: GEHA Commercial |
$56.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.00
|
| Rate for Payer: Multiplan All |
$72.80
|
| Rate for Payer: OMNI Networks Commercial |
$56.00
|
| Rate for Payer: One Health Plan PPO/POS |
$72.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.00
|
| Rate for Payer: Three Rivers Provider Network All |
$60.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$74.40
|
| Rate for Payer: Zelis Auto |
$32.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.05
|
|
|
uric acid body fluid REF019505
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
22990909
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$68.00
|
| Rate for Payer: First Health Commercial |
$72.00
|
| Rate for Payer: First Health Workers Compensation |
$8.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.00
|
| Rate for Payer: GEHA Commercial |
$56.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.00
|
| Rate for Payer: Multiplan All |
$72.80
|
| Rate for Payer: OMNI Networks Commercial |
$56.00
|
| Rate for Payer: One Health Plan PPO/POS |
$72.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.00
|
| Rate for Payer: Three Rivers Provider Network All |
$60.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$74.40
|
| Rate for Payer: Zelis Auto |
$32.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.05
|
|
