|
CYSTATIN C REF
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
2300030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.74 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$30.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$18.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$20.37
|
| Rate for Payer: Humana Medicare Advantage |
$18.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$31.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.52
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.48
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$31.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$37.04
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.15
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.52
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$15.74
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.22
|
| Rate for Payer: Zelis Worker's Compensation |
$21.64
|
|
|
cystatin c REF121251
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
2200081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.74 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$30.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$18.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$20.37
|
| Rate for Payer: Humana Medicare Advantage |
$18.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$31.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.52
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.48
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$31.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$37.04
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.15
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.52
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$15.74
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.22
|
| Rate for Payer: Zelis Worker's Compensation |
$21.64
|
|
|
cystatin c REF121251
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
2200081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$30.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$21.64
|
|
|
CYSTO CALIBRATION DILAT URTL STRIX/STENO
|
Facility
|
OP
|
$897.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
9200007
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$244.88 |
| Max. Negotiated Rate |
$3,890.28 |
| 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 |
$538.20
|
| 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 |
$1,945.14
|
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cigna Commercial |
$762.45
|
| Rate for Payer: First Health Commercial |
$807.30
|
| Rate for Payer: First Health Workers Compensation |
$346.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$807.30
|
| Rate for Payer: GEHA Commercial |
$717.60
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$807.30
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$816.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$627.90
|
| Rate for Payer: One Health Plan PPO/POS |
$807.30
|
| 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 |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$852.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$672.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$834.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$358.80
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$244.88
|
|
|
CYSTO CALIBRATION DILAT URTL STRIX/STENO
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
6152281
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$408.00
|
| Rate for Payer: First Health Commercial |
$432.00
|
| Rate for Payer: First Health Workers Compensation |
$185.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.00
|
| Rate for Payer: GEHA Commercial |
$336.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.00
|
| Rate for Payer: Multiplan All |
$436.80
|
| Rate for Payer: OMNI Networks Commercial |
$336.00
|
| Rate for Payer: One Health Plan PPO/POS |
$432.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.00
|
| Rate for Payer: Three Rivers Provider Network All |
$360.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$446.40
|
| Rate for Payer: Zelis Auto |
$192.00
|
| Rate for Payer: Zelis Worker's Compensation |
$131.04
|
|
|
CYSTO CALIBRATION DILAT URTL STRIX/STENO
|
Facility
|
IP
|
$897.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
9200007
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$244.88 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cigna Commercial |
$762.45
|
| Rate for Payer: First Health Commercial |
$807.30
|
| Rate for Payer: First Health Workers Compensation |
$346.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$807.30
|
| Rate for Payer: GEHA Commercial |
$627.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$807.30
|
| Rate for Payer: Multiplan All |
$816.27
|
| Rate for Payer: OMNI Networks Commercial |
$627.90
|
| Rate for Payer: One Health Plan PPO/POS |
$807.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$852.15
|
| Rate for Payer: Three Rivers Provider Network All |
$672.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$834.21
|
| Rate for Payer: Zelis Auto |
$358.80
|
| Rate for Payer: Zelis Worker's Compensation |
$244.88
|
|
|
CYSTO CALIBRATION DILAT URTL STRIX/STENO
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
6152281
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$3,890.28 |
| 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 |
$288.00
|
| 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 |
$1,945.14
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$408.00
|
| Rate for Payer: First Health Commercial |
$432.00
|
| Rate for Payer: First Health Workers Compensation |
$185.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.00
|
| Rate for Payer: GEHA Commercial |
$384.00
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.00
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$436.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$336.00
|
| Rate for Payer: One Health Plan PPO/POS |
$432.00
|
| 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 |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$360.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$446.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$192.00
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$131.04
|
|
|
CYSTO INSERT TRANSPROSTATIC IMPLNT SINGL
|
Facility
|
OP
|
$3,596.00
|
|
|
Service Code
|
CPT 52441
|
| Hospital Charge Code |
6152441
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$899.00 |
| Max. Negotiated Rate |
$3,416.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,157.60
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cigna Commercial |
$3,056.60
|
| Rate for Payer: First Health Commercial |
$3,236.40
|
| Rate for Payer: First Health Workers Compensation |
$1,388.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,236.40
|
| Rate for Payer: GEHA Commercial |
$2,876.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,236.40
|
| Rate for Payer: Humana ChoiceCare |
$934.96
|
| Rate for Payer: Multiplan All |
$3,272.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,157.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,517.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,236.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,416.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,697.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,164.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$899.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,344.28
|
| Rate for Payer: Zelis Auto |
$1,438.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,798.00
|
| Rate for Payer: Zelis Worker's Compensation |
$981.71
|
|
|
CYSTO INSERT TRANSPROSTATIC IMPLNT SINGL
|
Facility
|
IP
|
$3,596.00
|
|
|
Service Code
|
CPT 52441
|
| Hospital Charge Code |
6152441
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$981.71 |
| Max. Negotiated Rate |
$3,416.20 |
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cigna Commercial |
$3,056.60
|
| Rate for Payer: First Health Commercial |
$3,236.40
|
| Rate for Payer: First Health Workers Compensation |
$1,388.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,236.40
|
| Rate for Payer: GEHA Commercial |
$2,517.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,236.40
|
| Rate for Payer: Multiplan All |
$3,272.36
|
| Rate for Payer: OMNI Networks Commercial |
$2,517.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,236.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,416.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,697.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,344.28
|
| Rate for Payer: Zelis Auto |
$1,438.40
|
| Rate for Payer: Zelis Worker's Compensation |
$981.71
|
|
|
CYSTO INSERT TRANSPROSTATIC IMPLNT SINGL
|
Facility
|
IP
|
$3,596.00
|
|
|
Service Code
|
CPT 52441
|
| Hospital Charge Code |
8952441
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$981.71 |
| Max. Negotiated Rate |
$3,416.20 |
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cigna Commercial |
$3,056.60
|
| Rate for Payer: First Health Commercial |
$3,236.40
|
| Rate for Payer: First Health Workers Compensation |
$1,388.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,236.40
|
| Rate for Payer: GEHA Commercial |
$2,517.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,236.40
|
| Rate for Payer: Multiplan All |
$3,272.36
|
| Rate for Payer: OMNI Networks Commercial |
$2,517.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,236.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,416.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,697.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,344.28
|
| Rate for Payer: Zelis Auto |
$1,438.40
|
| Rate for Payer: Zelis Worker's Compensation |
$981.71
|
|
|
CYSTO INSERT TRANSPROSTATIC IMPLNT SINGL
|
Facility
|
IP
|
$3,596.00
|
|
|
Service Code
|
CPT 52441
|
| Hospital Charge Code |
9200024
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$981.71 |
| Max. Negotiated Rate |
$3,416.20 |
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cigna Commercial |
$3,056.60
|
| Rate for Payer: First Health Commercial |
$3,236.40
|
| Rate for Payer: First Health Workers Compensation |
$1,388.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,236.40
|
| Rate for Payer: GEHA Commercial |
$2,517.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,236.40
|
| Rate for Payer: Multiplan All |
$3,272.36
|
| Rate for Payer: OMNI Networks Commercial |
$2,517.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,236.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,416.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,697.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,344.28
|
| Rate for Payer: Zelis Auto |
$1,438.40
|
| Rate for Payer: Zelis Worker's Compensation |
$981.71
|
|
|
CYSTO INSERT TRANSPROSTATIC IMPLNT SINGL
|
Facility
|
OP
|
$3,596.00
|
|
|
Service Code
|
CPT 52441
|
| Hospital Charge Code |
9200024
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$899.00 |
| Max. Negotiated Rate |
$3,416.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,157.60
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cigna Commercial |
$3,056.60
|
| Rate for Payer: First Health Commercial |
$3,236.40
|
| Rate for Payer: First Health Workers Compensation |
$1,388.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,236.40
|
| Rate for Payer: GEHA Commercial |
$2,876.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,236.40
|
| Rate for Payer: Humana ChoiceCare |
$934.96
|
| Rate for Payer: Multiplan All |
$3,272.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,157.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,517.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,236.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,416.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,697.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,164.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$899.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,344.28
|
| Rate for Payer: Zelis Auto |
$1,438.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,798.00
|
| Rate for Payer: Zelis Worker's Compensation |
$981.71
|
|
|
CYSTO INSERT TRANSPROSTATIC IMPLNT SINGL
|
Facility
|
OP
|
$3,596.00
|
|
|
Service Code
|
CPT 52441
|
| Hospital Charge Code |
8952441
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$899.00 |
| Max. Negotiated Rate |
$3,416.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,157.60
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cigna Commercial |
$3,056.60
|
| Rate for Payer: First Health Commercial |
$3,236.40
|
| Rate for Payer: First Health Workers Compensation |
$1,388.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,236.40
|
| Rate for Payer: GEHA Commercial |
$2,876.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,236.40
|
| Rate for Payer: Humana ChoiceCare |
$934.96
|
| Rate for Payer: Multiplan All |
$3,272.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,157.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,517.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,236.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,416.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,697.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,164.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$899.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,344.28
|
| Rate for Payer: Zelis Auto |
$1,438.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,798.00
|
| Rate for Payer: Zelis Worker's Compensation |
$981.71
|
|
|
CYSTO INSRT TRANSPROSTATIC IMPLNT EA AD
|
Facility
|
OP
|
$2,724.00
|
|
|
Service Code
|
CPT 52442
|
| Hospital Charge Code |
6152442
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$681.00 |
| Max. Negotiated Rate |
$2,587.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cigna Commercial |
$2,315.40
|
| Rate for Payer: First Health Commercial |
$2,451.60
|
| Rate for Payer: First Health Workers Compensation |
$1,051.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,451.60
|
| Rate for Payer: GEHA Commercial |
$2,179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,451.60
|
| Rate for Payer: Humana ChoiceCare |
$708.24
|
| Rate for Payer: Multiplan All |
$2,478.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,634.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,906.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,451.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,587.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,043.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,397.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,533.32
|
| Rate for Payer: Zelis Auto |
$1,089.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,362.00
|
| Rate for Payer: Zelis Worker's Compensation |
$743.65
|
|
|
CYSTO INSRT TRANSPROSTATIC IMPLNT EA AD
|
Facility
|
IP
|
$2,724.00
|
|
|
Service Code
|
CPT 52442
|
| Hospital Charge Code |
9200025
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$743.65 |
| Max. Negotiated Rate |
$2,587.80 |
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cigna Commercial |
$2,315.40
|
| Rate for Payer: First Health Commercial |
$2,451.60
|
| Rate for Payer: First Health Workers Compensation |
$1,051.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,451.60
|
| Rate for Payer: GEHA Commercial |
$1,906.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,451.60
|
| Rate for Payer: Multiplan All |
$2,478.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,906.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,451.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,587.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,043.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,533.32
|
| Rate for Payer: Zelis Auto |
$1,089.60
|
| Rate for Payer: Zelis Worker's Compensation |
$743.65
|
|
|
CYSTO INSRT TRANSPROSTATIC IMPLNT EA AD
|
Facility
|
IP
|
$2,724.00
|
|
|
Service Code
|
CPT 52442
|
| Hospital Charge Code |
8952442
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$743.65 |
| Max. Negotiated Rate |
$2,587.80 |
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cigna Commercial |
$2,315.40
|
| Rate for Payer: First Health Commercial |
$2,451.60
|
| Rate for Payer: First Health Workers Compensation |
$1,051.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,451.60
|
| Rate for Payer: GEHA Commercial |
$1,906.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,451.60
|
| Rate for Payer: Multiplan All |
$2,478.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,906.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,451.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,587.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,043.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,533.32
|
| Rate for Payer: Zelis Auto |
$1,089.60
|
| Rate for Payer: Zelis Worker's Compensation |
$743.65
|
|
|
CYSTO INSRT TRANSPROSTATIC IMPLNT EA AD
|
Facility
|
OP
|
$2,724.00
|
|
|
Service Code
|
CPT 52442
|
| Hospital Charge Code |
8952442
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$681.00 |
| Max. Negotiated Rate |
$2,587.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cigna Commercial |
$2,315.40
|
| Rate for Payer: First Health Commercial |
$2,451.60
|
| Rate for Payer: First Health Workers Compensation |
$1,051.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,451.60
|
| Rate for Payer: GEHA Commercial |
$2,179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,451.60
|
| Rate for Payer: Humana ChoiceCare |
$708.24
|
| Rate for Payer: Multiplan All |
$2,478.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,634.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,906.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,451.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,587.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,043.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,397.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,533.32
|
| Rate for Payer: Zelis Auto |
$1,089.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,362.00
|
| Rate for Payer: Zelis Worker's Compensation |
$743.65
|
|
|
CYSTO INSRT TRANSPROSTATIC IMPLNT EA AD
|
Facility
|
IP
|
$2,724.00
|
|
|
Service Code
|
CPT 52442
|
| Hospital Charge Code |
6152442
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$743.65 |
| Max. Negotiated Rate |
$2,587.80 |
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cigna Commercial |
$2,315.40
|
| Rate for Payer: First Health Commercial |
$2,451.60
|
| Rate for Payer: First Health Workers Compensation |
$1,051.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,451.60
|
| Rate for Payer: GEHA Commercial |
$1,906.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,451.60
|
| Rate for Payer: Multiplan All |
$2,478.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,906.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,451.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,587.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,043.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,533.32
|
| Rate for Payer: Zelis Auto |
$1,089.60
|
| Rate for Payer: Zelis Worker's Compensation |
$743.65
|
|
|
CYSTO INSRT TRANSPROSTATIC IMPLNT EA AD
|
Facility
|
OP
|
$2,724.00
|
|
|
Service Code
|
CPT 52442
|
| Hospital Charge Code |
8952443
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$681.00 |
| Max. Negotiated Rate |
$2,587.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cigna Commercial |
$2,315.40
|
| Rate for Payer: First Health Commercial |
$2,451.60
|
| Rate for Payer: First Health Workers Compensation |
$1,051.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,451.60
|
| Rate for Payer: GEHA Commercial |
$2,179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,451.60
|
| Rate for Payer: Humana ChoiceCare |
$708.24
|
| Rate for Payer: Multiplan All |
$2,478.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,634.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,906.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,451.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,587.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,043.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,397.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,533.32
|
| Rate for Payer: Zelis Auto |
$1,089.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,362.00
|
| Rate for Payer: Zelis Worker's Compensation |
$743.65
|
|
|
CYSTO INSRT TRANSPROSTATIC IMPLNT EA AD
|
Facility
|
IP
|
$2,724.00
|
|
|
Service Code
|
CPT 52442
|
| Hospital Charge Code |
8952443
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$743.65 |
| Max. Negotiated Rate |
$2,587.80 |
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cigna Commercial |
$2,315.40
|
| Rate for Payer: First Health Commercial |
$2,451.60
|
| Rate for Payer: First Health Workers Compensation |
$1,051.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,451.60
|
| Rate for Payer: GEHA Commercial |
$1,906.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,451.60
|
| Rate for Payer: Multiplan All |
$2,478.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,906.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,451.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,587.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,043.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,533.32
|
| Rate for Payer: Zelis Auto |
$1,089.60
|
| Rate for Payer: Zelis Worker's Compensation |
$743.65
|
|
|
CYSTO INSRT TRANSPROSTATIC IMPLNT EA AD
|
Facility
|
OP
|
$2,724.00
|
|
|
Service Code
|
CPT 52442
|
| Hospital Charge Code |
9200025
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$681.00 |
| Max. Negotiated Rate |
$2,587.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cigna Commercial |
$2,315.40
|
| Rate for Payer: First Health Commercial |
$2,451.60
|
| Rate for Payer: First Health Workers Compensation |
$1,051.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,451.60
|
| Rate for Payer: GEHA Commercial |
$2,179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,451.60
|
| Rate for Payer: Humana ChoiceCare |
$708.24
|
| Rate for Payer: Multiplan All |
$2,478.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,634.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,906.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,451.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,587.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,043.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,397.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,533.32
|
| Rate for Payer: Zelis Auto |
$1,089.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,362.00
|
| Rate for Payer: Zelis Worker's Compensation |
$743.65
|
|
|
CYSTOMETROGRAM W/UP
|
Facility
|
OP
|
$2,085.00
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
6151727
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.01 |
| Max. Negotiated Rate |
$1,980.75 |
| 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 |
$1,251.00
|
| 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 |
$1,251.00
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$1,772.25
|
| Rate for Payer: First Health Commercial |
$1,876.50
|
| Rate for Payer: First Health Workers Compensation |
$805.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,876.50
|
| Rate for Payer: GEHA Commercial |
$1,668.00
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,876.50
|
| 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 |
$1,897.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,459.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,876.50
|
| 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 |
$1,980.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$1,563.75
|
| 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 |
$1,939.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$834.00
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$569.21
|
|
|
CYSTOMETROGRAM W/UP
|
Facility
|
IP
|
$2,085.00
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
6151727
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$569.21 |
| Max. Negotiated Rate |
$1,980.75 |
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$1,772.25
|
| Rate for Payer: First Health Commercial |
$1,876.50
|
| Rate for Payer: First Health Workers Compensation |
$805.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,876.50
|
| Rate for Payer: GEHA Commercial |
$1,459.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,876.50
|
| Rate for Payer: Multiplan All |
$1,897.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,459.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,876.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,980.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,563.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,939.05
|
| Rate for Payer: Zelis Auto |
$834.00
|
| Rate for Payer: Zelis Worker's Compensation |
$569.21
|
|
|
CYSTOMETROGRAM W/VP
|
Facility
|
IP
|
$2,532.00
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
6151728
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$691.24 |
| Max. Negotiated Rate |
$2,405.40 |
| Rate for Payer: Cash Price |
$1,519.20
|
| Rate for Payer: Cigna Commercial |
$2,152.20
|
| Rate for Payer: First Health Commercial |
$2,278.80
|
| Rate for Payer: First Health Workers Compensation |
$977.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,278.80
|
| Rate for Payer: GEHA Commercial |
$1,772.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,278.80
|
| Rate for Payer: Multiplan All |
$2,304.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,772.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,278.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,405.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,899.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,354.76
|
| Rate for Payer: Zelis Auto |
$1,012.80
|
| Rate for Payer: Zelis Worker's Compensation |
$691.24
|
|
|
CYSTOMETROGRAM W/VP
|
Facility
|
OP
|
$2,532.00
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
6151728
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.01 |
| Max. Negotiated Rate |
$2,405.40 |
| 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 |
$1,519.20
|
| 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 |
$1,519.20
|
| Rate for Payer: Cash Price |
$1,519.20
|
| Rate for Payer: Cigna Commercial |
$2,152.20
|
| Rate for Payer: First Health Commercial |
$2,278.80
|
| Rate for Payer: First Health Workers Compensation |
$977.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,278.80
|
| Rate for Payer: GEHA Commercial |
$2,025.60
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,278.80
|
| 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 |
$2,304.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,772.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,278.80
|
| 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 |
$2,405.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$1,899.00
|
| 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 |
$2,354.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$1,012.80
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$691.24
|
|
