|
CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE; SIMPLE
|
Facility
|
OP
|
$17,920.60
|
|
|
Service Code
|
CPT 51860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,044.30 |
| Max. Negotiated Rate |
$17,920.60 |
| 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 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 |
$8,960.30
|
| Rate for Payer: First Health Workers Compensation |
$11,531.91
|
| Rate for Payer: GEHA Medicare |
$8,960.30
|
| Rate for Payer: Humana ChoiceCare |
$9,856.33
|
| Rate for Payer: Humana Medicare Advantage |
$8,960.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15,053.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,960.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15,232.51
|
| 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 |
$8,960.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17,920.60
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,781.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,960.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8,960.30
|
| Rate for Payer: Zelis Medicare |
$7,616.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,752.36
|
| Rate for Payer: Zelis Worker's Compensation |
$8,153.87
|
|
|
CYSTOSCOPY AND BIOPSY
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 52007
|
| Hospital Charge Code |
6152007
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.32 |
| Max. Negotiated Rate |
$6,683.96 |
| 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 |
$308.40
|
| 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 |
$3,341.98
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$436.90
|
| Rate for Payer: First Health Commercial |
$462.60
|
| Rate for Payer: First Health Workers Compensation |
$198.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$462.60
|
| Rate for Payer: GEHA Commercial |
$411.20
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$462.60
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$467.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$359.80
|
| Rate for Payer: One Health Plan PPO/POS |
$462.60
|
| 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 |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$488.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$385.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$205.60
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$140.32
|
|
|
CYSTOSCOPY AND BIOPSY
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 52007
|
| Hospital Charge Code |
6152007
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.32 |
| Max. Negotiated Rate |
$488.30 |
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$436.90
|
| Rate for Payer: First Health Commercial |
$462.60
|
| Rate for Payer: First Health Workers Compensation |
$198.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$462.60
|
| Rate for Payer: GEHA Commercial |
$359.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$462.60
|
| Rate for Payer: Multiplan All |
$467.74
|
| Rate for Payer: OMNI Networks Commercial |
$359.80
|
| Rate for Payer: One Health Plan PPO/POS |
$462.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$488.30
|
| Rate for Payer: Three Rivers Provider Network All |
$385.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.02
|
| Rate for Payer: Zelis Auto |
$205.60
|
| Rate for Payer: Zelis Worker's Compensation |
$140.32
|
|
|
CYSTOSCOPY AND RADIOTRACER
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 52250
|
| Hospital Charge Code |
6152250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$169.81 |
| Max. Negotiated Rate |
$590.90 |
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$528.70
|
| Rate for Payer: First Health Commercial |
$559.80
|
| Rate for Payer: First Health Workers Compensation |
$240.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$559.80
|
| Rate for Payer: GEHA Commercial |
$435.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$559.80
|
| Rate for Payer: Multiplan All |
$566.02
|
| Rate for Payer: OMNI Networks Commercial |
$435.40
|
| Rate for Payer: One Health Plan PPO/POS |
$559.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$590.90
|
| Rate for Payer: Three Rivers Provider Network All |
$466.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$578.46
|
| Rate for Payer: Zelis Auto |
$248.80
|
| Rate for Payer: Zelis Worker's Compensation |
$169.81
|
|
|
CYSTOSCOPY AND RADIOTRACER
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 52250
|
| Hospital Charge Code |
6152250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$169.81 |
| Max. Negotiated Rate |
$6,683.96 |
| 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 |
$373.20
|
| 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 |
$3,341.98
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$528.70
|
| Rate for Payer: First Health Commercial |
$559.80
|
| Rate for Payer: First Health Workers Compensation |
$240.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$559.80
|
| Rate for Payer: GEHA Commercial |
$497.60
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$559.80
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$566.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$435.40
|
| Rate for Payer: One Health Plan PPO/POS |
$559.80
|
| 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 |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$590.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$466.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$578.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$248.80
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$169.81
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
CPT 52300
|
| Hospital Charge Code |
6152300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$691.60 |
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$618.80
|
| Rate for Payer: First Health Commercial |
$655.20
|
| Rate for Payer: First Health Workers Compensation |
$281.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$655.20
|
| Rate for Payer: GEHA Commercial |
$509.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$655.20
|
| Rate for Payer: Multiplan All |
$662.48
|
| Rate for Payer: OMNI Networks Commercial |
$509.60
|
| Rate for Payer: One Health Plan PPO/POS |
$655.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$691.60
|
| Rate for Payer: Three Rivers Provider Network All |
$546.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$677.04
|
| Rate for Payer: Zelis Auto |
$291.20
|
| Rate for Payer: Zelis Worker's Compensation |
$198.74
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT 52290
|
| Hospital Charge Code |
6152290
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$172.54 |
| Max. Negotiated Rate |
$3,969.94 |
| 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 |
$379.20
|
| 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 |
$1,984.97
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: First Health Workers Compensation |
$244.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$505.60
|
| Rate for Payer: GEHA Medicare |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Humana ChoiceCare |
$2,183.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,984.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,334.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| 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 |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$252.80
|
| Rate for Payer: Zelis Medicare |
$1,687.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,381.96
|
| Rate for Payer: Zelis Worker's Compensation |
$172.54
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT 52265
|
| Hospital Charge Code |
6152265
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.87 |
| Max. Negotiated Rate |
$479.75 |
| Rate for Payer: Cash Price |
$303.00
|
| Rate for Payer: Cigna Commercial |
$429.25
|
| Rate for Payer: First Health Commercial |
$454.50
|
| Rate for Payer: First Health Workers Compensation |
$194.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$454.50
|
| Rate for Payer: GEHA Commercial |
$353.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$454.50
|
| Rate for Payer: Multiplan All |
$459.55
|
| Rate for Payer: OMNI Networks Commercial |
$353.50
|
| Rate for Payer: One Health Plan PPO/POS |
$454.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$479.75
|
| Rate for Payer: Three Rivers Provider Network All |
$378.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$469.65
|
| Rate for Payer: Zelis Auto |
$202.00
|
| Rate for Payer: Zelis Worker's Compensation |
$137.87
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$752.00
|
|
|
Service Code
|
CPT 52301
|
| Hospital Charge Code |
6152301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$205.30 |
| Max. Negotiated Rate |
$6,683.96 |
| 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 |
$451.20
|
| 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 |
$3,341.98
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cigna Commercial |
$639.20
|
| Rate for Payer: First Health Commercial |
$676.80
|
| Rate for Payer: First Health Workers Compensation |
$290.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$676.80
|
| Rate for Payer: GEHA Commercial |
$601.60
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$676.80
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$684.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$526.40
|
| Rate for Payer: One Health Plan PPO/POS |
$676.80
|
| 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 |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$714.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$564.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$699.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$300.80
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$205.30
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 52330
|
| Hospital Charge Code |
6152330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$186.73 |
| Max. Negotiated Rate |
$6,683.96 |
| 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 |
$410.40
|
| 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 |
$3,341.98
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cigna Commercial |
$581.40
|
| Rate for Payer: First Health Commercial |
$615.60
|
| Rate for Payer: First Health Workers Compensation |
$264.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$615.60
|
| Rate for Payer: GEHA Commercial |
$547.20
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$615.60
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$622.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$478.80
|
| Rate for Payer: One Health Plan PPO/POS |
$615.60
|
| 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 |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$649.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$513.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$636.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$273.60
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$186.73
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
CPT 52300
|
| Hospital Charge Code |
6152300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$6,683.96 |
| 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 |
$436.80
|
| 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 |
$3,341.98
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$618.80
|
| Rate for Payer: First Health Commercial |
$655.20
|
| Rate for Payer: First Health Workers Compensation |
$281.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$655.20
|
| Rate for Payer: GEHA Commercial |
$582.40
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$655.20
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$662.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$509.60
|
| Rate for Payer: One Health Plan PPO/POS |
$655.20
|
| 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 |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$691.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$546.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$677.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$291.20
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$198.74
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 52276
|
| Hospital Charge Code |
6152276
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$187.28 |
| Max. Negotiated Rate |
$651.70 |
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$583.10
|
| Rate for Payer: First Health Commercial |
$617.40
|
| Rate for Payer: First Health Workers Compensation |
$264.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$617.40
|
| Rate for Payer: GEHA Commercial |
$480.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$617.40
|
| Rate for Payer: Multiplan All |
$624.26
|
| Rate for Payer: OMNI Networks Commercial |
$480.20
|
| Rate for Payer: One Health Plan PPO/POS |
$617.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$651.70
|
| Rate for Payer: Three Rivers Provider Network All |
$514.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.98
|
| Rate for Payer: Zelis Auto |
$274.40
|
| Rate for Payer: Zelis Worker's Compensation |
$187.28
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT 52283
|
| Hospital Charge Code |
6152283
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$142.51 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$443.70
|
| Rate for Payer: First Health Commercial |
$469.80
|
| Rate for Payer: First Health Workers Compensation |
$201.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$469.80
|
| Rate for Payer: GEHA Commercial |
$365.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$469.80
|
| Rate for Payer: Multiplan All |
$475.02
|
| Rate for Payer: OMNI Networks Commercial |
$365.40
|
| Rate for Payer: One Health Plan PPO/POS |
$469.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$495.90
|
| Rate for Payer: Three Rivers Provider Network All |
$391.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$485.46
|
| Rate for Payer: Zelis Auto |
$208.80
|
| Rate for Payer: Zelis Worker's Compensation |
$142.51
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 52277
|
| Hospital Charge Code |
6152277
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.05 |
| Max. Negotiated Rate |
$6,683.96 |
| 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 |
$503.40
|
| 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 |
$3,341.98
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$713.15
|
| Rate for Payer: First Health Commercial |
$755.10
|
| Rate for Payer: First Health Workers Compensation |
$323.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$755.10
|
| Rate for Payer: GEHA Commercial |
$671.20
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$755.10
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$763.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$587.30
|
| Rate for Payer: One Health Plan PPO/POS |
$755.10
|
| 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 |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$797.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$629.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$780.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$335.60
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$229.05
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
6152285
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$577.60 |
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$516.80
|
| Rate for Payer: First Health Commercial |
$547.20
|
| Rate for Payer: First Health Workers Compensation |
$234.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$547.20
|
| Rate for Payer: GEHA Commercial |
$425.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$547.20
|
| Rate for Payer: Multiplan All |
$553.28
|
| Rate for Payer: OMNI Networks Commercial |
$425.60
|
| Rate for Payer: One Health Plan PPO/POS |
$547.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$577.60
|
| Rate for Payer: Three Rivers Provider Network All |
$456.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$565.44
|
| Rate for Payer: Zelis Auto |
$243.20
|
| Rate for Payer: Zelis Worker's Compensation |
$165.98
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
CPT 52260
|
| Hospital Charge Code |
6152260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$148.78 |
| Max. Negotiated Rate |
$517.75 |
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$463.25
|
| Rate for Payer: First Health Commercial |
$490.50
|
| Rate for Payer: First Health Workers Compensation |
$210.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$490.50
|
| Rate for Payer: GEHA Commercial |
$381.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$490.50
|
| Rate for Payer: Multiplan All |
$495.95
|
| Rate for Payer: OMNI Networks Commercial |
$381.50
|
| Rate for Payer: One Health Plan PPO/POS |
$490.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$517.75
|
| Rate for Payer: Three Rivers Provider Network All |
$408.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$506.85
|
| Rate for Payer: Zelis Auto |
$218.00
|
| Rate for Payer: Zelis Worker's Compensation |
$148.78
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
CPT 52320
|
| Hospital Charge Code |
6152320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$6,683.96 |
| 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 |
$384.00
|
| 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 |
$3,341.98
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$544.00
|
| Rate for Payer: First Health Commercial |
$576.00
|
| Rate for Payer: First Health Workers Compensation |
$247.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.00
|
| Rate for Payer: GEHA Commercial |
$512.00
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.00
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$582.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$448.00
|
| Rate for Payer: One Health Plan PPO/POS |
$576.00
|
| 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 |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$480.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$595.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$256.00
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$174.72
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$1,018.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
6152240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$277.91 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Cash Price |
$610.80
|
| Rate for Payer: Cigna Commercial |
$865.30
|
| Rate for Payer: First Health Commercial |
$916.20
|
| Rate for Payer: First Health Workers Compensation |
$393.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$916.20
|
| Rate for Payer: GEHA Commercial |
$712.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$916.20
|
| Rate for Payer: Multiplan All |
$926.38
|
| Rate for Payer: OMNI Networks Commercial |
$712.60
|
| Rate for Payer: One Health Plan PPO/POS |
$916.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$763.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$946.74
|
| Rate for Payer: Zelis Auto |
$407.20
|
| Rate for Payer: Zelis Worker's Compensation |
$277.91
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
6152235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$204.48 |
| Max. Negotiated Rate |
$711.55 |
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$636.65
|
| Rate for Payer: First Health Commercial |
$674.10
|
| Rate for Payer: First Health Workers Compensation |
$289.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$674.10
|
| Rate for Payer: GEHA Commercial |
$524.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$674.10
|
| Rate for Payer: Multiplan All |
$681.59
|
| Rate for Payer: OMNI Networks Commercial |
$524.30
|
| Rate for Payer: One Health Plan PPO/POS |
$674.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$711.55
|
| Rate for Payer: Three Rivers Provider Network All |
$561.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$696.57
|
| Rate for Payer: Zelis Auto |
$299.60
|
| Rate for Payer: Zelis Worker's Compensation |
$204.48
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
CPT 52260
|
| Hospital Charge Code |
6152260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$148.78 |
| Max. Negotiated Rate |
$3,969.94 |
| 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 |
$327.00
|
| 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 |
$1,984.97
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$463.25
|
| Rate for Payer: First Health Commercial |
$490.50
|
| Rate for Payer: First Health Workers Compensation |
$210.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$490.50
|
| Rate for Payer: GEHA Commercial |
$436.00
|
| Rate for Payer: GEHA Medicare |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$490.50
|
| Rate for Payer: Humana ChoiceCare |
$2,183.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,984.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,334.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: Multiplan All |
$495.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| Rate for Payer: OMNI Networks Commercial |
$381.50
|
| Rate for Payer: One Health Plan PPO/POS |
$490.50
|
| 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 |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$517.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$408.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$506.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$218.00
|
| Rate for Payer: Zelis Medicare |
$1,687.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,381.96
|
| Rate for Payer: Zelis Worker's Compensation |
$148.78
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$1,021.89
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
6152332
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$278.98 |
| Max. Negotiated Rate |
$970.80 |
| Rate for Payer: Cash Price |
$613.13
|
| Rate for Payer: Cigna Commercial |
$868.61
|
| Rate for Payer: First Health Commercial |
$919.70
|
| Rate for Payer: First Health Workers Compensation |
$394.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$919.70
|
| Rate for Payer: GEHA Commercial |
$715.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$919.70
|
| Rate for Payer: Multiplan All |
$929.92
|
| Rate for Payer: OMNI Networks Commercial |
$715.32
|
| Rate for Payer: One Health Plan PPO/POS |
$919.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$970.80
|
| Rate for Payer: Three Rivers Provider Network All |
$766.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$950.36
|
| Rate for Payer: Zelis Auto |
$408.76
|
| Rate for Payer: Zelis Worker's Compensation |
$278.98
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 52330
|
| Hospital Charge Code |
6152330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$186.73 |
| Max. Negotiated Rate |
$649.80 |
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cigna Commercial |
$581.40
|
| Rate for Payer: First Health Commercial |
$615.60
|
| Rate for Payer: First Health Workers Compensation |
$264.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$615.60
|
| Rate for Payer: GEHA Commercial |
$478.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$615.60
|
| Rate for Payer: Multiplan All |
$622.44
|
| Rate for Payer: OMNI Networks Commercial |
$478.80
|
| Rate for Payer: One Health Plan PPO/POS |
$615.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$649.80
|
| Rate for Payer: Three Rivers Provider Network All |
$513.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$636.12
|
| Rate for Payer: Zelis Auto |
$273.60
|
| Rate for Payer: Zelis Worker's Compensation |
$186.73
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT 52283
|
| Hospital Charge Code |
6152283
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$142.51 |
| Max. Negotiated Rate |
$3,969.94 |
| 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 |
$313.20
|
| 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 |
$1,984.97
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$443.70
|
| Rate for Payer: First Health Commercial |
$469.80
|
| Rate for Payer: First Health Workers Compensation |
$201.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$469.80
|
| Rate for Payer: GEHA Commercial |
$417.60
|
| Rate for Payer: GEHA Medicare |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$469.80
|
| Rate for Payer: Humana ChoiceCare |
$2,183.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,984.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,334.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: Multiplan All |
$475.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| Rate for Payer: OMNI Networks Commercial |
$365.40
|
| Rate for Payer: One Health Plan PPO/POS |
$469.80
|
| 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 |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$495.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$391.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$485.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$208.80
|
| Rate for Payer: Zelis Medicare |
$1,687.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,381.96
|
| Rate for Payer: Zelis Worker's Compensation |
$142.51
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT 52265
|
| Hospital Charge Code |
6152265
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.87 |
| Max. Negotiated Rate |
$3,969.94 |
| 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 |
$303.00
|
| 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 |
$1,984.97
|
| Rate for Payer: Cash Price |
$303.00
|
| Rate for Payer: Cash Price |
$303.00
|
| Rate for Payer: Cigna Commercial |
$429.25
|
| Rate for Payer: First Health Commercial |
$454.50
|
| Rate for Payer: First Health Workers Compensation |
$194.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$454.50
|
| Rate for Payer: GEHA Commercial |
$404.00
|
| Rate for Payer: GEHA Medicare |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$454.50
|
| Rate for Payer: Humana ChoiceCare |
$2,183.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,984.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,334.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$583.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: Multiplan All |
$459.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| Rate for Payer: OMNI Networks Commercial |
$353.50
|
| Rate for Payer: One Health Plan PPO/POS |
$454.50
|
| 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 |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$479.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$378.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$469.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$202.00
|
| Rate for Payer: Zelis Medicare |
$1,687.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,381.96
|
| Rate for Payer: Zelis Worker's Compensation |
$137.87
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 52276
|
| Hospital Charge Code |
6152276
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$187.28 |
| Max. Negotiated Rate |
$3,969.94 |
| 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 |
$411.60
|
| 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 |
$1,984.97
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$583.10
|
| Rate for Payer: First Health Commercial |
$617.40
|
| Rate for Payer: First Health Workers Compensation |
$264.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$617.40
|
| Rate for Payer: GEHA Commercial |
$548.80
|
| Rate for Payer: GEHA Medicare |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$617.40
|
| Rate for Payer: Humana ChoiceCare |
$2,183.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,984.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,334.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: Multiplan All |
$624.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| Rate for Payer: OMNI Networks Commercial |
$480.20
|
| Rate for Payer: One Health Plan PPO/POS |
$617.40
|
| 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 |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$651.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$514.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$274.40
|
| Rate for Payer: Zelis Medicare |
$1,687.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,381.96
|
| Rate for Payer: Zelis Worker's Compensation |
$187.28
|
|
