|
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
|
|
|
CYSTOSCOPY STONE REMOVAL
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT 52325
|
| Hospital Charge Code |
6152325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.68 |
| Max. Negotiated Rate |
$792.30 |
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: First Health Commercial |
$750.60
|
| Rate for Payer: First Health Workers Compensation |
$322.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$750.60
|
| Rate for Payer: GEHA Commercial |
$583.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| Rate for Payer: Multiplan All |
$758.94
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$792.30
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$775.62
|
| Rate for Payer: Zelis Auto |
$333.60
|
| Rate for Payer: Zelis Worker's Compensation |
$227.68
|
|
|
CYSTOSCOPY STONE REMOVAL
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT 52325
|
| Hospital Charge Code |
6152325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.68 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$500.40
|
| 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 |
$4,827.10
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: First Health Commercial |
$750.60
|
| Rate for Payer: First Health Workers Compensation |
$322.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$750.60
|
| Rate for Payer: GEHA Commercial |
$667.20
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$758.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| 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 |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$792.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$775.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$333.60
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$227.68
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Facility
|
IP
|
$854.55
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
6152005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.29 |
| Max. Negotiated Rate |
$811.82 |
| Rate for Payer: Cash Price |
$512.73
|
| Rate for Payer: Cigna Commercial |
$726.37
|
| Rate for Payer: First Health Commercial |
$769.10
|
| Rate for Payer: First Health Workers Compensation |
$329.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$769.10
|
| Rate for Payer: GEHA Commercial |
$598.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$769.10
|
| Rate for Payer: Multiplan All |
$777.64
|
| Rate for Payer: OMNI Networks Commercial |
$598.18
|
| Rate for Payer: One Health Plan PPO/POS |
$769.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$811.82
|
| Rate for Payer: Three Rivers Provider Network All |
$640.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$794.73
|
| Rate for Payer: Zelis Auto |
$341.82
|
| Rate for Payer: Zelis Worker's Compensation |
$233.29
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Facility
|
OP
|
$854.55
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
6152005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.29 |
| Max. Negotiated Rate |
$3,890.28 |
| 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 |
$512.73
|
| 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 |
$1,945.14
|
| Rate for Payer: Cash Price |
$512.73
|
| Rate for Payer: Cash Price |
$512.73
|
| Rate for Payer: Cigna Commercial |
$726.37
|
| Rate for Payer: First Health Commercial |
$769.10
|
| Rate for Payer: First Health Workers Compensation |
$329.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$769.10
|
| Rate for Payer: GEHA Commercial |
$683.64
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$769.10
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$777.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$598.18
|
| Rate for Payer: One Health Plan PPO/POS |
$769.10
|
| 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 |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$811.82
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$640.91
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$794.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$341.82
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$233.29
|
|
|
CYSTOURETERO & OR PYELOSCOPE
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
CPT 52351
|
| Hospital Charge Code |
6152351
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$214.58 |
| Max. Negotiated Rate |
$6,549.86 |
| 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 |
$471.60
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna Commercial |
$668.10
|
| Rate for Payer: First Health Commercial |
$707.40
|
| Rate for Payer: First Health Workers Compensation |
$303.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$707.40
|
| Rate for Payer: GEHA Commercial |
$628.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$707.40
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$715.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$550.20
|
| Rate for Payer: One Health Plan PPO/POS |
$707.40
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$746.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$589.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$314.40
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$214.58
|
|
|
CYSTOURETERO & OR PYELOSCOPE
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
CPT 52351
|
| Hospital Charge Code |
6152351
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$214.58 |
| Max. Negotiated Rate |
$746.70 |
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna Commercial |
$668.10
|
| Rate for Payer: First Health Commercial |
$707.40
|
| Rate for Payer: First Health Workers Compensation |
$303.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$707.40
|
| Rate for Payer: GEHA Commercial |
$550.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$707.40
|
| Rate for Payer: Multiplan All |
$715.26
|
| Rate for Payer: OMNI Networks Commercial |
$550.20
|
| Rate for Payer: One Health Plan PPO/POS |
$707.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$746.70
|
| Rate for Payer: Three Rivers Provider Network All |
$589.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.98
|
| Rate for Payer: Zelis Auto |
$314.40
|
| Rate for Payer: Zelis Worker's Compensation |
$214.58
|
|
|
CYSTO/URETERO STRICTURE TX
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 52344
|
| Hospital Charge Code |
6152344
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.08 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$816.00
|
| Rate for Payer: First Health Commercial |
$864.00
|
| Rate for Payer: First Health Workers Compensation |
$370.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.00
|
| Rate for Payer: GEHA Commercial |
$672.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.00
|
| Rate for Payer: Multiplan All |
$873.60
|
| Rate for Payer: OMNI Networks Commercial |
$672.00
|
| Rate for Payer: One Health Plan PPO/POS |
$864.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.00
|
| Rate for Payer: Three Rivers Provider Network All |
$720.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$892.80
|
| Rate for Payer: Zelis Auto |
$384.00
|
| Rate for Payer: Zelis Worker's Compensation |
$262.08
|
|
|
CYSTO/URETERO STRICTURE TX
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 52344
|
| Hospital Charge Code |
6152344
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.08 |
| Max. Negotiated Rate |
$6,549.86 |
| 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 |
$576.00
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$816.00
|
| Rate for Payer: First Health Commercial |
$864.00
|
| Rate for Payer: First Health Workers Compensation |
$370.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.00
|
| Rate for Payer: GEHA Commercial |
$768.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.00
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$873.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$672.00
|
| Rate for Payer: One Health Plan PPO/POS |
$864.00
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$720.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$892.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$384.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$262.08
|
|
|
CYSTOURETERO W/BIOPSY
|
Facility
|
OP
|
$866.00
|
|
|
Service Code
|
CPT 52354
|
| Hospital Charge Code |
6152354
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.42 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$519.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cigna Commercial |
$736.10
|
| Rate for Payer: First Health Commercial |
$779.40
|
| Rate for Payer: First Health Workers Compensation |
$334.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$779.40
|
| Rate for Payer: GEHA Commercial |
$692.80
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$779.40
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$788.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$606.20
|
| Rate for Payer: One Health Plan PPO/POS |
$779.40
|
| 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 |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$822.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$649.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$805.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$346.40
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$236.42
|
|
|
CYSTOURETERO W/BIOPSY
|
Facility
|
IP
|
$866.00
|
|
|
Service Code
|
CPT 52354
|
| Hospital Charge Code |
6152354
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.42 |
| Max. Negotiated Rate |
$822.70 |
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cigna Commercial |
$736.10
|
| Rate for Payer: First Health Commercial |
$779.40
|
| Rate for Payer: First Health Workers Compensation |
$334.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$779.40
|
| Rate for Payer: GEHA Commercial |
$606.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$779.40
|
| Rate for Payer: Multiplan All |
$788.06
|
| Rate for Payer: OMNI Networks Commercial |
$606.20
|
| Rate for Payer: One Health Plan PPO/POS |
$779.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$822.70
|
| Rate for Payer: Three Rivers Provider Network All |
$649.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$805.38
|
| Rate for Payer: Zelis Auto |
$346.40
|
| Rate for Payer: Zelis Worker's Compensation |
$236.42
|
|
|
CYSTOURETERO W/CONGEN REPR
|
Facility
|
OP
|
$988.00
|
|
|
Service Code
|
CPT 52400
|
| Hospital Charge Code |
6152400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.72 |
| Max. Negotiated Rate |
$6,549.86 |
| 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 |
$592.80
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cigna Commercial |
$839.80
|
| Rate for Payer: First Health Commercial |
$889.20
|
| Rate for Payer: First Health Workers Compensation |
$381.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$889.20
|
| Rate for Payer: GEHA Commercial |
$790.40
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$889.20
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$899.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$691.60
|
| Rate for Payer: One Health Plan PPO/POS |
$889.20
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$938.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$741.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$918.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$395.20
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$269.72
|
|
|
CYSTOURETERO W/CONGEN REPR
|
Facility
|
IP
|
$988.00
|
|
|
Service Code
|
CPT 52400
|
| Hospital Charge Code |
6152400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.72 |
| Max. Negotiated Rate |
$938.60 |
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cigna Commercial |
$839.80
|
| Rate for Payer: First Health Commercial |
$889.20
|
| Rate for Payer: First Health Workers Compensation |
$381.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$889.20
|
| Rate for Payer: GEHA Commercial |
$691.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$889.20
|
| Rate for Payer: Multiplan All |
$899.08
|
| Rate for Payer: OMNI Networks Commercial |
$691.60
|
| Rate for Payer: One Health Plan PPO/POS |
$889.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$938.60
|
| Rate for Payer: Three Rivers Provider Network All |
$741.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$918.84
|
| Rate for Payer: Zelis Auto |
$395.20
|
| Rate for Payer: Zelis Worker's Compensation |
$269.72
|
|
|
CYSTOURETERO W/EXCISE TUMOR
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
CPT 52355
|
| Hospital Charge Code |
6152355
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$264.81 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$582.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$582.00
|
| Rate for Payer: Cash Price |
$582.00
|
| Rate for Payer: Cigna Commercial |
$824.50
|
| Rate for Payer: First Health Commercial |
$873.00
|
| Rate for Payer: First Health Workers Compensation |
$374.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$873.00
|
| Rate for Payer: GEHA Commercial |
$776.00
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$873.00
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$882.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$679.00
|
| Rate for Payer: One Health Plan PPO/POS |
$873.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$921.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$727.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$902.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$388.00
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$264.81
|
|
|
CYSTOURETERO W/EXCISE TUMOR
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
CPT 52355
|
| Hospital Charge Code |
6152355
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$264.81 |
| Max. Negotiated Rate |
$921.50 |
| Rate for Payer: Cash Price |
$582.00
|
| Rate for Payer: Cigna Commercial |
$824.50
|
| Rate for Payer: First Health Commercial |
$873.00
|
| Rate for Payer: First Health Workers Compensation |
$374.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$873.00
|
| Rate for Payer: GEHA Commercial |
$679.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$873.00
|
| Rate for Payer: Multiplan All |
$882.70
|
| Rate for Payer: OMNI Networks Commercial |
$679.00
|
| Rate for Payer: One Health Plan PPO/POS |
$873.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$921.50
|
| Rate for Payer: Three Rivers Provider Network All |
$727.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$902.10
|
| Rate for Payer: Zelis Auto |
$388.00
|
| Rate for Payer: Zelis Worker's Compensation |
$264.81
|
|
|
CYSTO/URETERO W/LITHOTRIPSY
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
6152356
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.87 |
| Max. Negotiated Rate |
$820.80 |
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna Commercial |
$734.40
|
| Rate for Payer: First Health Commercial |
$777.60
|
| Rate for Payer: First Health Workers Compensation |
$333.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$777.60
|
| Rate for Payer: GEHA Commercial |
$604.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$777.60
|
| Rate for Payer: Multiplan All |
$786.24
|
| Rate for Payer: OMNI Networks Commercial |
$604.80
|
| Rate for Payer: One Health Plan PPO/POS |
$777.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$820.80
|
| Rate for Payer: Three Rivers Provider Network All |
$648.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$803.52
|
| Rate for Payer: Zelis Auto |
$345.60
|
| Rate for Payer: Zelis Worker's Compensation |
$235.87
|
|
|
CYSTO/URETERO W/LITHOTRIPSY
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
6152356
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.87 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$518.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna Commercial |
$734.40
|
| Rate for Payer: First Health Commercial |
$777.60
|
| Rate for Payer: First Health Workers Compensation |
$333.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$777.60
|
| Rate for Payer: GEHA Commercial |
$691.20
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$777.60
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$786.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$604.80
|
| Rate for Payer: One Health Plan PPO/POS |
$777.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$820.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$648.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$803.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$345.60
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$235.87
|
|
|
CYSTOURETERO W/LITHOTRIPSY
|
Facility
|
OP
|
$1,018.00
|
|
|
Service Code
|
CPT 52353
|
| Hospital Charge Code |
6152353
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$277.91 |
| Max. Negotiated Rate |
$9,654.20 |
| 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 |
$610.80
|
| 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 |
$4,827.10
|
| 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 |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$916.20
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,958.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$926.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| 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 |
$3,416.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,958.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$967.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$763.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,958.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$946.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$407.20
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$277.91
|
|
|
CYSTOURETERO W/LITHOTRIPSY
|
Facility
|
IP
|
$1,018.00
|
|
|
Service Code
|
CPT 52353
|
| Hospital Charge Code |
6152353
|
|
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
|
|
|
CYSTOURETERO W/RENAL STRICT
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
CPT 52346
|
| Hospital Charge Code |
6152346
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.07 |
| Max. Negotiated Rate |
$880.65 |
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cigna Commercial |
$787.95
|
| Rate for Payer: First Health Commercial |
$834.30
|
| Rate for Payer: First Health Workers Compensation |
$357.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$834.30
|
| Rate for Payer: GEHA Commercial |
$648.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$834.30
|
| Rate for Payer: Multiplan All |
$843.57
|
| Rate for Payer: OMNI Networks Commercial |
$648.90
|
| Rate for Payer: One Health Plan PPO/POS |
$834.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$880.65
|
| Rate for Payer: Three Rivers Provider Network All |
$695.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$862.11
|
| Rate for Payer: Zelis Auto |
$370.80
|
| Rate for Payer: Zelis Worker's Compensation |
$253.07
|
|
|
CYSTOURETERO W/RENAL STRICT
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
CPT 52346
|
| Hospital Charge Code |
6152346
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.07 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.20
|
| 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 |
$4,827.10
|
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cigna Commercial |
$787.95
|
| Rate for Payer: First Health Commercial |
$834.30
|
| Rate for Payer: First Health Workers Compensation |
$357.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$834.30
|
| Rate for Payer: GEHA Commercial |
$741.60
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$834.30
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$843.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$648.90
|
| Rate for Payer: One Health Plan PPO/POS |
$834.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$880.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$695.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$862.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$370.80
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$253.07
|
|
|
CYSTOURETERO W/STONE REMOVE
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
CPT 52352
|
| Hospital Charge Code |
6152352
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$6,549.86 |
| 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 |
$552.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$782.00
|
| Rate for Payer: First Health Commercial |
$828.00
|
| Rate for Payer: First Health Workers Compensation |
$355.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$828.00
|
| Rate for Payer: GEHA Commercial |
$736.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$828.00
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$837.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$644.00
|
| Rate for Payer: One Health Plan PPO/POS |
$828.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$874.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$690.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$855.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$368.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$251.16
|
|
|
CYSTOURETERO W/STONE REMOVE
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
CPT 52352
|
| Hospital Charge Code |
6152352
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$782.00
|
| Rate for Payer: First Health Commercial |
$828.00
|
| Rate for Payer: First Health Workers Compensation |
$355.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$828.00
|
| Rate for Payer: GEHA Commercial |
$644.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$828.00
|
| Rate for Payer: Multiplan All |
$837.20
|
| Rate for Payer: OMNI Networks Commercial |
$644.00
|
| Rate for Payer: One Health Plan PPO/POS |
$828.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$874.00
|
| Rate for Payer: Three Rivers Provider Network All |
$690.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$855.60
|
| Rate for Payer: Zelis Auto |
$368.00
|
| Rate for Payer: Zelis Worker's Compensation |
$251.16
|
|
|
CYSTO/URETERO W/UP STRICTURE
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 52345
|
| Hospital Charge Code |
6152345
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.86 |
| Max. Negotiated Rate |
$6,549.86 |
| 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 |
$492.00
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$697.00
|
| Rate for Payer: First Health Commercial |
$738.00
|
| Rate for Payer: First Health Workers Compensation |
$316.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.00
|
| Rate for Payer: GEHA Commercial |
$656.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.00
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$746.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$574.00
|
| Rate for Payer: One Health Plan PPO/POS |
$738.00
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$615.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$762.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$328.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$223.86
|
|
|
CYSTO/URETERO W/UP STRICTURE
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 52345
|
| Hospital Charge Code |
6152345
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.86 |
| Max. Negotiated Rate |
$779.00 |
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$697.00
|
| Rate for Payer: First Health Commercial |
$738.00
|
| Rate for Payer: First Health Workers Compensation |
$316.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.00
|
| Rate for Payer: GEHA Commercial |
$574.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.00
|
| Rate for Payer: Multiplan All |
$746.20
|
| Rate for Payer: OMNI Networks Commercial |
$574.00
|
| Rate for Payer: One Health Plan PPO/POS |
$738.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.00
|
| Rate for Payer: Three Rivers Provider Network All |
$615.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$762.60
|
| Rate for Payer: Zelis Auto |
$328.00
|
| Rate for Payer: Zelis Worker's Compensation |
$223.86
|
|
