|
COMPLETE REMOVAL OF VULVA
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
CPT 56625
|
| Hospital Charge Code |
6156625
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$352.99 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$775.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$1,099.05
|
| Rate for Payer: First Health Commercial |
$1,163.70
|
| Rate for Payer: First Health Workers Compensation |
$499.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,163.70
|
| Rate for Payer: GEHA Commercial |
$1,034.40
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,163.70
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$1,176.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$905.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,163.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,228.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$969.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,202.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$517.20
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$352.99
|
|
|
COMPLETE REMOVAL OF VULVA
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
CPT 56625
|
| Hospital Charge Code |
6156625
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$352.99 |
| Max. Negotiated Rate |
$1,228.35 |
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$1,099.05
|
| Rate for Payer: First Health Commercial |
$1,163.70
|
| Rate for Payer: First Health Workers Compensation |
$499.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,163.70
|
| Rate for Payer: GEHA Commercial |
$905.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,163.70
|
| Rate for Payer: Multiplan All |
$1,176.63
|
| Rate for Payer: OMNI Networks Commercial |
$905.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,163.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,228.35
|
| Rate for Payer: Three Rivers Provider Network All |
$969.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,202.49
|
| Rate for Payer: Zelis Auto |
$517.20
|
| Rate for Payer: Zelis Worker's Compensation |
$352.99
|
|
|
COMPLETE REPLACEMENT PICC RS&I
|
Facility
|
IP
|
$3,048.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
336584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$832.10 |
| Max. Negotiated Rate |
$2,895.60 |
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$2,590.80
|
| Rate for Payer: First Health Commercial |
$2,743.20
|
| Rate for Payer: First Health Workers Compensation |
$1,176.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,743.20
|
| Rate for Payer: GEHA Commercial |
$2,133.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,743.20
|
| Rate for Payer: Multiplan All |
$2,773.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,133.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,743.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,895.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,834.64
|
| Rate for Payer: Zelis Auto |
$1,219.20
|
| Rate for Payer: Zelis Worker's Compensation |
$832.10
|
|
|
COMPLEX CYSTOMETROGRAM
|
Facility
|
OP
|
$3,358.00
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
6151726
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.30 |
| Max. Negotiated Rate |
$3,190.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,014.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$2,014.80
|
| Rate for Payer: Cash Price |
$2,014.80
|
| Rate for Payer: Cigna Commercial |
$2,854.30
|
| Rate for Payer: First Health Commercial |
$3,022.20
|
| Rate for Payer: First Health Workers Compensation |
$1,296.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,022.20
|
| Rate for Payer: GEHA Commercial |
$2,686.40
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,022.20
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$246.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$3,055.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,350.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,022.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$285.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$246.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,190.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$2,518.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,122.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$1,343.20
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$916.73
|
|
|
COMPLEX CYSTOMETROGRAM
|
Facility
|
IP
|
$3,358.00
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
6151726
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$916.73 |
| Max. Negotiated Rate |
$3,190.10 |
| Rate for Payer: Cash Price |
$2,014.80
|
| Rate for Payer: Cigna Commercial |
$2,854.30
|
| Rate for Payer: First Health Commercial |
$3,022.20
|
| Rate for Payer: First Health Workers Compensation |
$1,296.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,022.20
|
| Rate for Payer: GEHA Commercial |
$2,350.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,022.20
|
| Rate for Payer: Multiplan All |
$3,055.78
|
| Rate for Payer: OMNI Networks Commercial |
$2,350.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,022.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,190.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,518.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,122.94
|
| Rate for Payer: Zelis Auto |
$1,343.20
|
| Rate for Payer: Zelis Worker's Compensation |
$916.73
|
|
|
COMPLEX CYSTOMETROGRAM URETHRAL PRESS PR
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
23500047
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$1,267.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$453.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cigna Commercial |
$642.60
|
| Rate for Payer: First Health Commercial |
$680.40
|
| Rate for Payer: First Health Workers Compensation |
$291.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$680.40
|
| Rate for Payer: GEHA Commercial |
$604.80
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$680.40
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$246.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$687.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$529.20
|
| Rate for Payer: One Health Plan PPO/POS |
$680.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$285.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$246.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$718.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$567.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$703.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$302.40
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$206.39
|
|
|
COMPLEX CYSTOMETROGRAM URETHRAL PRESS PR
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
23500047
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$718.20 |
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cigna Commercial |
$642.60
|
| Rate for Payer: First Health Commercial |
$680.40
|
| Rate for Payer: First Health Workers Compensation |
$291.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$680.40
|
| Rate for Payer: GEHA Commercial |
$529.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$680.40
|
| Rate for Payer: Multiplan All |
$687.96
|
| Rate for Payer: OMNI Networks Commercial |
$529.20
|
| Rate for Payer: One Health Plan PPO/POS |
$680.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$718.20
|
| Rate for Payer: Three Rivers Provider Network All |
$567.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$703.08
|
| Rate for Payer: Zelis Auto |
$302.40
|
| Rate for Payer: Zelis Worker's Compensation |
$206.39
|
|
|
COMPLEX CYSTOMETROGRAM VOIDING PRESSURE
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
23500048
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$208.03 |
| Max. Negotiated Rate |
$723.90 |
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$647.70
|
| Rate for Payer: First Health Commercial |
$685.80
|
| Rate for Payer: First Health Workers Compensation |
$294.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$685.80
|
| Rate for Payer: GEHA Commercial |
$533.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$685.80
|
| Rate for Payer: Multiplan All |
$693.42
|
| Rate for Payer: OMNI Networks Commercial |
$533.40
|
| Rate for Payer: One Health Plan PPO/POS |
$685.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$723.90
|
| Rate for Payer: Three Rivers Provider Network All |
$571.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$708.66
|
| Rate for Payer: Zelis Auto |
$304.80
|
| Rate for Payer: Zelis Worker's Compensation |
$208.03
|
|
|
COMPLEX CYSTOMETROGRAM VOIDING PRESSURE
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
23500048
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$208.03 |
| Max. Negotiated Rate |
$1,267.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$457.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$647.70
|
| Rate for Payer: First Health Commercial |
$685.80
|
| Rate for Payer: First Health Workers Compensation |
$294.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$685.80
|
| Rate for Payer: GEHA Commercial |
$609.60
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$685.80
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$246.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$693.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$533.40
|
| Rate for Payer: One Health Plan PPO/POS |
$685.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$285.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$246.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$723.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$571.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$708.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$304.80
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$208.03
|
|
|
COMPLEX E/M VISIT ADD ON
|
Facility
|
OP
|
$45.75
|
|
|
Service Code
|
CPT G2211
|
| Hospital Charge Code |
192211
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$43.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.01
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna Commercial |
$38.89
|
| Rate for Payer: First Health Commercial |
$41.17
|
| Rate for Payer: First Health Workers Compensation |
$17.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.17
|
| Rate for Payer: GEHA Commercial |
$36.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.17
|
| Rate for Payer: Humana ChoiceCare |
$11.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.40
|
| Rate for Payer: Multiplan All |
$41.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.45
|
| Rate for Payer: OMNI Networks Commercial |
$32.02
|
| Rate for Payer: One Health Plan PPO/POS |
$41.17
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.46
|
| Rate for Payer: Three Rivers Provider Network All |
$34.31
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$40.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.55
|
| Rate for Payer: Zelis Auto |
$18.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.88
|
| Rate for Payer: Zelis Worker's Compensation |
$12.49
|
|
|
COMPLEX E/M VISIT ADD ON
|
Facility
|
IP
|
$45.75
|
|
|
Service Code
|
CPT G2211
|
| Hospital Charge Code |
192211
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$43.46 |
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna Commercial |
$38.89
|
| Rate for Payer: First Health Commercial |
$41.17
|
| Rate for Payer: First Health Workers Compensation |
$17.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.17
|
| Rate for Payer: GEHA Commercial |
$32.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.17
|
| Rate for Payer: Multiplan All |
$41.63
|
| Rate for Payer: OMNI Networks Commercial |
$32.02
|
| Rate for Payer: One Health Plan PPO/POS |
$41.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.46
|
| Rate for Payer: Three Rivers Provider Network All |
$34.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.55
|
| Rate for Payer: Zelis Auto |
$18.30
|
| Rate for Payer: Zelis Worker's Compensation |
$12.49
|
|
|
COMPLEX UROFLOMETRY
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
23551741
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$48.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$34.40
|
|
|
COMPLEX UROFLOMETRY
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
23551741
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$48.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$34.40
|
|
|
COMPLEX UROFLOMETRY
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
8900014
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$41.80 |
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$37.40
|
| Rate for Payer: First Health Commercial |
$39.60
|
| Rate for Payer: First Health Workers Compensation |
$16.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$39.60
|
| Rate for Payer: GEHA Commercial |
$30.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$39.60
|
| Rate for Payer: Multiplan All |
$40.04
|
| Rate for Payer: OMNI Networks Commercial |
$30.80
|
| Rate for Payer: One Health Plan PPO/POS |
$39.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$41.80
|
| Rate for Payer: Three Rivers Provider Network All |
$33.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$40.92
|
| Rate for Payer: Zelis Auto |
$17.60
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
COMPLEX UROFLOMETRY
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
6151741
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$37.40
|
| Rate for Payer: First Health Commercial |
$39.60
|
| Rate for Payer: First Health Workers Compensation |
$16.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$39.60
|
| Rate for Payer: GEHA Commercial |
$35.20
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$39.60
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$40.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$30.80
|
| Rate for Payer: One Health Plan PPO/POS |
$39.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$41.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$33.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$40.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$17.60
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
COMPLEX UROFLOMETRY
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
6151741
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$41.80 |
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$37.40
|
| Rate for Payer: First Health Commercial |
$39.60
|
| Rate for Payer: First Health Workers Compensation |
$16.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$39.60
|
| Rate for Payer: GEHA Commercial |
$30.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$39.60
|
| Rate for Payer: Multiplan All |
$40.04
|
| Rate for Payer: OMNI Networks Commercial |
$30.80
|
| Rate for Payer: One Health Plan PPO/POS |
$39.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$41.80
|
| Rate for Payer: Three Rivers Provider Network All |
$33.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$40.92
|
| Rate for Payer: Zelis Auto |
$17.60
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
COMPLEX UROFLOMETRY
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
23500043
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$37.40
|
| Rate for Payer: First Health Commercial |
$39.60
|
| Rate for Payer: First Health Workers Compensation |
$16.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$39.60
|
| Rate for Payer: GEHA Commercial |
$35.20
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$39.60
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$40.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$30.80
|
| Rate for Payer: One Health Plan PPO/POS |
$39.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$41.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$33.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$40.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$17.60
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
COMPLEX UROFLOMETRY
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
23500043
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$41.80 |
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$37.40
|
| Rate for Payer: First Health Commercial |
$39.60
|
| Rate for Payer: First Health Workers Compensation |
$16.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$39.60
|
| Rate for Payer: GEHA Commercial |
$30.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$39.60
|
| Rate for Payer: Multiplan All |
$40.04
|
| Rate for Payer: OMNI Networks Commercial |
$30.80
|
| Rate for Payer: One Health Plan PPO/POS |
$39.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$41.80
|
| Rate for Payer: Three Rivers Provider Network All |
$33.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$40.92
|
| Rate for Payer: Zelis Auto |
$17.60
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
COMPLEX UROFLOMETRY
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
8900014
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$37.40
|
| Rate for Payer: First Health Commercial |
$39.60
|
| Rate for Payer: First Health Workers Compensation |
$16.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$39.60
|
| Rate for Payer: GEHA Commercial |
$35.20
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$39.60
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$40.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$30.80
|
| Rate for Payer: One Health Plan PPO/POS |
$39.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$41.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$33.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$40.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$17.60
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
COMPLX CYSTOMETRO W/VOID PRESS & URETHRA
|
Facility
|
IP
|
$1,652.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
6151729
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$451.00 |
| Max. Negotiated Rate |
$1,569.40 |
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cigna Commercial |
$1,404.20
|
| Rate for Payer: First Health Commercial |
$1,486.80
|
| Rate for Payer: First Health Workers Compensation |
$637.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,486.80
|
| Rate for Payer: GEHA Commercial |
$1,156.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,486.80
|
| Rate for Payer: Multiplan All |
$1,503.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,156.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,486.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,569.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,239.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,536.36
|
| Rate for Payer: Zelis Auto |
$660.80
|
| Rate for Payer: Zelis Worker's Compensation |
$451.00
|
|
|
COMPLX CYSTOMETRO W/VOID PRESS & URETHRA
|
Facility
|
IP
|
$975.36
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
23551729
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$266.27 |
| Max. Negotiated Rate |
$926.59 |
| Rate for Payer: Cash Price |
$585.22
|
| Rate for Payer: Cigna Commercial |
$829.06
|
| Rate for Payer: First Health Commercial |
$877.82
|
| Rate for Payer: First Health Workers Compensation |
$376.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$877.82
|
| Rate for Payer: GEHA Commercial |
$682.75
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$877.82
|
| Rate for Payer: Multiplan All |
$887.58
|
| Rate for Payer: OMNI Networks Commercial |
$682.75
|
| Rate for Payer: One Health Plan PPO/POS |
$877.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$926.59
|
| Rate for Payer: Three Rivers Provider Network All |
$731.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$907.08
|
| Rate for Payer: Zelis Auto |
$390.14
|
| Rate for Payer: Zelis Worker's Compensation |
$266.27
|
|
|
COMPLX CYSTOMETRO W/VOID PRESS & URETHRA
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
23500049
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$225.50 |
| Max. Negotiated Rate |
$1,267.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$495.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cigna Commercial |
$702.10
|
| Rate for Payer: First Health Commercial |
$743.40
|
| Rate for Payer: First Health Workers Compensation |
$318.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$743.40
|
| Rate for Payer: GEHA Commercial |
$660.80
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$743.40
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$246.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$751.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$578.20
|
| Rate for Payer: One Health Plan PPO/POS |
$743.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$285.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$246.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$784.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$619.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$768.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$330.40
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$225.50
|
|
|
COMPLX CYSTOMETRO W/VOID PRESS & URETHRA
|
Facility
|
OP
|
$1,652.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
6151729
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.01 |
| Max. Negotiated Rate |
$1,569.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$991.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cigna Commercial |
$1,404.20
|
| Rate for Payer: First Health Commercial |
$1,486.80
|
| Rate for Payer: First Health Workers Compensation |
$637.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,486.80
|
| Rate for Payer: GEHA Commercial |
$1,321.60
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,486.80
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$246.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$1,503.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,156.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,486.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$285.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$246.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,569.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$1,239.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,536.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$660.80
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$451.00
|
|
|
COMPLX CYSTOMETRO W/VOID PRESS & URETHRA
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
23500049
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$225.50 |
| Max. Negotiated Rate |
$784.70 |
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cigna Commercial |
$702.10
|
| Rate for Payer: First Health Commercial |
$743.40
|
| Rate for Payer: First Health Workers Compensation |
$318.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$743.40
|
| Rate for Payer: GEHA Commercial |
$578.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$743.40
|
| Rate for Payer: Multiplan All |
$751.66
|
| Rate for Payer: OMNI Networks Commercial |
$578.20
|
| Rate for Payer: One Health Plan PPO/POS |
$743.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$784.70
|
| Rate for Payer: Three Rivers Provider Network All |
$619.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$768.18
|
| Rate for Payer: Zelis Auto |
$330.40
|
| Rate for Payer: Zelis Worker's Compensation |
$225.50
|
|
|
COMPLX CYSTOMETRO W/VOID PRESS & URETHRA
|
Facility
|
IP
|
$975.36
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
8951729
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$266.27 |
| Max. Negotiated Rate |
$926.59 |
| Rate for Payer: Cash Price |
$585.22
|
| Rate for Payer: Cigna Commercial |
$829.06
|
| Rate for Payer: First Health Commercial |
$877.82
|
| Rate for Payer: First Health Workers Compensation |
$376.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$877.82
|
| Rate for Payer: GEHA Commercial |
$682.75
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$877.82
|
| Rate for Payer: Multiplan All |
$887.58
|
| Rate for Payer: OMNI Networks Commercial |
$682.75
|
| Rate for Payer: One Health Plan PPO/POS |
$877.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$926.59
|
| Rate for Payer: Three Rivers Provider Network All |
$731.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$907.08
|
| Rate for Payer: Zelis Auto |
$390.14
|
| Rate for Payer: Zelis Worker's Compensation |
$266.27
|
|
