|
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
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
6152214
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$152.61 |
| 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 |
$335.40
|
| 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 |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: First Health Workers Compensation |
$215.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$447.20
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| 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 |
$508.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| 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 |
$531.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| 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 |
$519.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$223.60
|
| 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 |
$152.61
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
CPT 52320
|
| Hospital Charge Code |
6152320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$608.00 |
| 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 |
$448.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.00
|
| Rate for Payer: Multiplan All |
$582.40
|
| Rate for Payer: OMNI Networks Commercial |
$448.00
|
| Rate for Payer: One Health Plan PPO/POS |
$576.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.00
|
| Rate for Payer: Three Rivers Provider Network All |
$480.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$595.20
|
| Rate for Payer: Zelis Auto |
$256.00
|
| Rate for Payer: Zelis Worker's Compensation |
$174.72
|
|
|
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
|
OP
|
$749.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
6152235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$204.48 |
| 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 |
$449.40
|
| 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 |
$449.40
|
| 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 |
$599.20
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$674.10
|
| 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 |
$681.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$524.30
|
| Rate for Payer: One Health Plan PPO/POS |
$674.10
|
| 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 |
$711.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$561.75
|
| 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 |
$696.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$299.60
|
| 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 |
$204.48
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
6152285
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$1,722.33 |
| 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 |
$364.80
|
| 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 |
$646.77
|
| Rate for Payer: Cash Price |
$364.80
|
| 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 |
$486.40
|
| Rate for Payer: GEHA Medicare |
$646.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$547.20
|
| Rate for Payer: Humana ChoiceCare |
$711.45
|
| Rate for Payer: Humana Medicare Advantage |
$646.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,086.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$646.77
|
| Rate for Payer: Multiplan All |
$553.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,099.51
|
| Rate for Payer: OMNI Networks Commercial |
$425.60
|
| Rate for Payer: One Health Plan PPO/POS |
$547.20
|
| 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 |
$646.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$577.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,293.54
|
| Rate for Payer: Three Rivers Provider Network All |
$456.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$633.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$646.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$565.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$646.77
|
| Rate for Payer: Zelis Auto |
$243.20
|
| Rate for Payer: Zelis Medicare |
$549.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$776.12
|
| Rate for Payer: Zelis Worker's Compensation |
$165.98
|
|
|
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
|
$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
|
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
|
IP
|
$632.00
|
|
|
Service Code
|
CPT 52290
|
| Hospital Charge Code |
6152290
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$172.54 |
| Max. Negotiated Rate |
$600.40 |
| 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 |
$442.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
| Rate for Payer: Zelis Worker's Compensation |
$172.54
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$1,018.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
6152240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$277.91 |
| Max. Negotiated Rate |
$9,851.86 |
| 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 |
$610.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,925.93
|
| Rate for Payer: Cash Price |
$610.80
|
| 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 |
$814.40
|
| Rate for Payer: GEHA Medicare |
$4,925.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$916.20
|
| Rate for Payer: Humana ChoiceCare |
$5,418.52
|
| Rate for Payer: Humana Medicare Advantage |
$4,925.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,275.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,925.93
|
| Rate for Payer: Multiplan All |
$926.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,374.08
|
| Rate for Payer: OMNI Networks Commercial |
$712.60
|
| Rate for Payer: One Health Plan PPO/POS |
$916.20
|
| 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 |
$4,925.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$967.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,851.86
|
| Rate for Payer: Three Rivers Provider Network All |
$763.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,827.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,925.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$946.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,925.93
|
| Rate for Payer: Zelis Auto |
$407.20
|
| Rate for Payer: Zelis Medicare |
$4,187.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,911.12
|
| Rate for Payer: Zelis Worker's Compensation |
$277.91
|
|
|
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 CHEMODENERVATION
|
Facility
|
IP
|
$1,093.86
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
6152287
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.62 |
| Max. Negotiated Rate |
$1,039.17 |
| Rate for Payer: Cash Price |
$656.32
|
| Rate for Payer: Cigna Commercial |
$929.78
|
| Rate for Payer: First Health Commercial |
$984.47
|
| Rate for Payer: First Health Workers Compensation |
$422.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.47
|
| Rate for Payer: GEHA Commercial |
$765.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.47
|
| Rate for Payer: Multiplan All |
$995.41
|
| Rate for Payer: OMNI Networks Commercial |
$765.70
|
| Rate for Payer: One Health Plan PPO/POS |
$984.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.17
|
| Rate for Payer: Three Rivers Provider Network All |
$820.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.29
|
| Rate for Payer: Zelis Auto |
$437.54
|
| Rate for Payer: Zelis Worker's Compensation |
$298.62
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
OP
|
$1,093.86
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
6152287
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.62 |
| Max. Negotiated Rate |
$3,969.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,603.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$656.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,603.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,270.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,984.97
|
| Rate for Payer: Cash Price |
$656.32
|
| Rate for Payer: Cash Price |
$656.32
|
| Rate for Payer: Cigna Commercial |
$929.78
|
| Rate for Payer: First Health Commercial |
$984.47
|
| Rate for Payer: First Health Workers Compensation |
$422.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.47
|
| Rate for Payer: GEHA Commercial |
$875.09
|
| Rate for Payer: GEHA Medicare |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.47
|
| 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 |
$1,296.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: Multiplan All |
$995.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| Rate for Payer: OMNI Networks Commercial |
$765.70
|
| Rate for Payer: One Health Plan PPO/POS |
$984.47
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,497.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,296.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.17
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$820.39
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,296.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$437.54
|
| 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 |
$298.62
|
|
|
CYSTOSCOPY & DUCT CATHETER
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 52010
|
| Hospital Charge Code |
6152010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.69 |
| Max. Negotiated Rate |
$1,293.54 |
| 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 |
$311.40
|
| 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 |
$646.77
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna Commercial |
$441.15
|
| Rate for Payer: First Health Commercial |
$467.10
|
| Rate for Payer: First Health Workers Compensation |
$200.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$467.10
|
| Rate for Payer: GEHA Commercial |
$415.20
|
| Rate for Payer: GEHA Medicare |
$646.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$467.10
|
| Rate for Payer: Humana ChoiceCare |
$711.45
|
| Rate for Payer: Humana Medicare Advantage |
$646.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,086.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$583.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$646.77
|
| Rate for Payer: Multiplan All |
$472.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,099.51
|
| Rate for Payer: OMNI Networks Commercial |
$363.30
|
| Rate for Payer: One Health Plan PPO/POS |
$467.10
|
| 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 |
$646.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$493.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,293.54
|
| Rate for Payer: Three Rivers Provider Network All |
$389.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$633.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$646.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$482.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$646.77
|
| Rate for Payer: Zelis Auto |
$207.60
|
| Rate for Payer: Zelis Medicare |
$549.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$776.12
|
| Rate for Payer: Zelis Worker's Compensation |
$141.69
|
|
|
CYSTOSCOPY & DUCT CATHETER
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 52010
|
| Hospital Charge Code |
6152010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.69 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna Commercial |
$441.15
|
| Rate for Payer: First Health Commercial |
$467.10
|
| Rate for Payer: First Health Workers Compensation |
$200.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$467.10
|
| Rate for Payer: GEHA Commercial |
$363.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$467.10
|
| Rate for Payer: Multiplan All |
$472.29
|
| Rate for Payer: OMNI Networks Commercial |
$363.30
|
| Rate for Payer: One Health Plan PPO/POS |
$467.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$493.05
|
| Rate for Payer: Three Rivers Provider Network All |
$389.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$482.67
|
| Rate for Payer: Zelis Auto |
$207.60
|
| Rate for Payer: Zelis Worker's Compensation |
$141.69
|
|
|
CYSTOSCOPY IMPLANT STENT
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
CPT 52282
|
| Hospital Charge Code |
6152282
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.60 |
| Max. Negotiated Rate |
$6,683.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$524.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,899.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,341.98
|
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cigna Commercial |
$742.90
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: First Health Workers Compensation |
$337.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$786.60
|
| Rate for Payer: GEHA Commercial |
$699.20
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$786.60
|
| 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 |
$2,958.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$795.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$611.80
|
| Rate for Payer: One Health Plan PPO/POS |
$786.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,416.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,958.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$830.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$655.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,958.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$812.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$349.60
|
| 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 |
$238.60
|
|
|
CYSTOSCOPY IMPLANT STENT
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
CPT 52282
|
| Hospital Charge Code |
6152282
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.60 |
| Max. Negotiated Rate |
$830.30 |
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cigna Commercial |
$742.90
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: First Health Workers Compensation |
$337.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$786.60
|
| Rate for Payer: GEHA Commercial |
$611.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$786.60
|
| Rate for Payer: Multiplan All |
$795.34
|
| Rate for Payer: OMNI Networks Commercial |
$611.80
|
| Rate for Payer: One Health Plan PPO/POS |
$786.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$830.30
|
| Rate for Payer: Three Rivers Provider Network All |
$655.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$812.82
|
| Rate for Payer: Zelis Auto |
$349.60
|
| Rate for Payer: Zelis Worker's Compensation |
$238.60
|
|
|
CYSTOSCOPY INJECT MATERIAL
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
CPT 52327
|
| Hospital Charge Code |
6152327
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$186.19 |
| Max. Negotiated Rate |
$647.90 |
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$579.70
|
| Rate for Payer: First Health Commercial |
$613.80
|
| Rate for Payer: First Health Workers Compensation |
$263.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$613.80
|
| Rate for Payer: GEHA Commercial |
$477.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$613.80
|
| Rate for Payer: Multiplan All |
$620.62
|
| Rate for Payer: OMNI Networks Commercial |
$477.40
|
| Rate for Payer: One Health Plan PPO/POS |
$613.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$647.90
|
| Rate for Payer: Three Rivers Provider Network All |
$511.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$634.26
|
| Rate for Payer: Zelis Auto |
$272.80
|
| Rate for Payer: Zelis Worker's Compensation |
$186.19
|
|
|
CYSTOSCOPY INJECT MATERIAL
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
CPT 52327
|
| Hospital Charge Code |
6152327
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$186.19 |
| Max. Negotiated Rate |
$9,851.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$409.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,899.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,925.93
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$579.70
|
| Rate for Payer: First Health Commercial |
$613.80
|
| Rate for Payer: First Health Workers Compensation |
$263.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$613.80
|
| Rate for Payer: GEHA Commercial |
$545.60
|
| Rate for Payer: GEHA Medicare |
$4,925.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$613.80
|
| Rate for Payer: Humana ChoiceCare |
$5,418.52
|
| Rate for Payer: Humana Medicare Advantage |
$4,925.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,275.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,958.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,925.93
|
| Rate for Payer: Multiplan All |
$620.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,374.08
|
| Rate for Payer: OMNI Networks Commercial |
$477.40
|
| Rate for Payer: One Health Plan PPO/POS |
$613.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,416.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,958.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,925.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$647.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,851.86
|
| Rate for Payer: Three Rivers Provider Network All |
$511.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,827.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,958.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,925.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$634.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,925.93
|
| Rate for Payer: Zelis Auto |
$272.80
|
| Rate for Payer: Zelis Medicare |
$4,187.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,911.12
|
| Rate for Payer: Zelis Worker's Compensation |
$186.19
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
6152001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$203.38 |
| Max. Negotiated Rate |
$6,683.96 |
| 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 |
$447.00
|
| 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 |
$3,341.98
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$633.25
|
| Rate for Payer: First Health Commercial |
$670.50
|
| Rate for Payer: First Health Workers Compensation |
$287.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$670.50
|
| Rate for Payer: GEHA Commercial |
$596.00
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$670.50
|
| 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 |
$1,392.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$677.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$521.50
|
| Rate for Payer: One Health Plan PPO/POS |
$670.50
|
| 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 |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$707.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$558.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$692.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$298.00
|
| 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 |
$203.38
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
6152001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$203.38 |
| Max. Negotiated Rate |
$707.75 |
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$633.25
|
| Rate for Payer: First Health Commercial |
$670.50
|
| Rate for Payer: First Health Workers Compensation |
$287.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$670.50
|
| Rate for Payer: GEHA Commercial |
$521.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$670.50
|
| Rate for Payer: Multiplan All |
$677.95
|
| Rate for Payer: OMNI Networks Commercial |
$521.50
|
| Rate for Payer: One Health Plan PPO/POS |
$670.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$707.75
|
| Rate for Payer: Three Rivers Provider Network All |
$558.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$692.85
|
| Rate for Payer: Zelis Auto |
$298.00
|
| Rate for Payer: Zelis Worker's Compensation |
$203.38
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT 52270
|
| Hospital Charge Code |
6152270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$153.97 |
| 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 |
$338.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,722.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,364.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,984.97
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cigna Commercial |
$479.40
|
| Rate for Payer: First Health Commercial |
$507.60
|
| Rate for Payer: First Health Workers Compensation |
$217.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$507.60
|
| Rate for Payer: GEHA Commercial |
$451.20
|
| Rate for Payer: GEHA Medicare |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$507.60
|
| 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 |
$513.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| Rate for Payer: OMNI Networks Commercial |
$394.80
|
| Rate for Payer: One Health Plan PPO/POS |
$507.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,607.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$535.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$423.00
|
| 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 |
$524.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$225.60
|
| 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 |
$153.97
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT 52270
|
| Hospital Charge Code |
6152270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$153.97 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cigna Commercial |
$479.40
|
| Rate for Payer: First Health Commercial |
$507.60
|
| Rate for Payer: First Health Workers Compensation |
$217.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$507.60
|
| Rate for Payer: GEHA Commercial |
$394.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$507.60
|
| Rate for Payer: Multiplan All |
$513.24
|
| Rate for Payer: OMNI Networks Commercial |
$394.80
|
| Rate for Payer: One Health Plan PPO/POS |
$507.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$535.80
|
| Rate for Payer: Three Rivers Provider Network All |
$423.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$524.52
|
| Rate for Payer: Zelis Auto |
$225.60
|
| Rate for Payer: Zelis Worker's Compensation |
$153.97
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 52275
|
| Hospital Charge Code |
6152275
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$176.09 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$548.25
|
| Rate for Payer: First Health Commercial |
$580.50
|
| Rate for Payer: First Health Workers Compensation |
$249.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$580.50
|
| Rate for Payer: GEHA Commercial |
$451.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$580.50
|
| Rate for Payer: Multiplan All |
$586.95
|
| Rate for Payer: OMNI Networks Commercial |
$451.50
|
| Rate for Payer: One Health Plan PPO/POS |
$580.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$612.75
|
| Rate for Payer: Three Rivers Provider Network All |
$483.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$599.85
|
| Rate for Payer: Zelis Auto |
$258.00
|
| Rate for Payer: Zelis Worker's Compensation |
$176.09
|
|
