|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH REMOVAL OR MANIPULATION OF CALCULUS (URETERAL CATHETERIZATION IS INCLUDED)
|
Facility
|
OP
|
$6,549.86
|
|
|
Service Code
|
CPT 52352
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,044.30 |
| 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 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: First Health Workers Compensation |
$4,214.83
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| 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: New Mexico Health Connections Medicare |
$5,567.38
|
| 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 Worker's Compensation |
$6,549.86
|
| 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: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| 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 |
$2,980.19
|
|
|
CYSTO W/COMPLEX REMOVAL STONE & STENT
|
Facility
|
OP
|
$1,341.46
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
6152315
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.22 |
| 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 |
$804.88
|
| 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 |
$804.88
|
| Rate for Payer: Cash Price |
$804.88
|
| Rate for Payer: Cigna Commercial |
$1,140.24
|
| Rate for Payer: First Health Commercial |
$1,207.31
|
| Rate for Payer: First Health Workers Compensation |
$517.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,207.31
|
| Rate for Payer: GEHA Commercial |
$1,073.17
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,207.31
|
| 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 |
$1,220.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$939.02
|
| Rate for Payer: One Health Plan PPO/POS |
$1,207.31
|
| 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 |
$1,274.39
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$1,006.10
|
| 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 |
$1,247.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$536.58
|
| 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 |
$366.22
|
|
|
CYSTO W/COMPLEX REMOVAL STONE & STENT
|
Facility
|
IP
|
$1,341.46
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
6152315
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.22 |
| Max. Negotiated Rate |
$1,274.39 |
| Rate for Payer: Cash Price |
$804.88
|
| Rate for Payer: Cigna Commercial |
$1,140.24
|
| Rate for Payer: First Health Commercial |
$1,207.31
|
| Rate for Payer: First Health Workers Compensation |
$517.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,207.31
|
| Rate for Payer: GEHA Commercial |
$939.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,207.31
|
| Rate for Payer: Multiplan All |
$1,220.73
|
| Rate for Payer: OMNI Networks Commercial |
$939.02
|
| Rate for Payer: One Health Plan PPO/POS |
$1,207.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,274.39
|
| Rate for Payer: Three Rivers Provider Network All |
$1,006.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,247.56
|
| Rate for Payer: Zelis Auto |
$536.58
|
| Rate for Payer: Zelis Worker's Compensation |
$366.22
|
|
|
CYSTO W/REMOVAL OF LESIONS SMALL
|
Facility
|
IP
|
$1,669.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
9200005
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$455.64 |
| Max. Negotiated Rate |
$1,585.55 |
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$1,418.65
|
| Rate for Payer: First Health Commercial |
$1,502.10
|
| Rate for Payer: First Health Workers Compensation |
$644.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,502.10
|
| Rate for Payer: GEHA Commercial |
$1,168.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,502.10
|
| Rate for Payer: Multiplan All |
$1,518.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,168.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,502.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,585.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,251.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,552.17
|
| Rate for Payer: Zelis Auto |
$667.60
|
| Rate for Payer: Zelis Worker's Compensation |
$455.64
|
|
|
CYSTO W/REMOVAL OF LESIONS SMALL
|
Facility
|
OP
|
$1,669.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
6152224
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$455.64 |
| 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 |
$1,001.40
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$1,418.65
|
| Rate for Payer: First Health Commercial |
$1,502.10
|
| Rate for Payer: First Health Workers Compensation |
$644.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,502.10
|
| Rate for Payer: GEHA Commercial |
$1,335.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,502.10
|
| 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 |
$1,518.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,168.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,502.10
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,585.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,251.75
|
| 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 |
$1,552.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$667.60
|
| 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 |
$455.64
|
|
|
CYSTO W/REMOVAL OF LESIONS SMALL
|
Facility
|
OP
|
$1,669.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
9200005
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$455.64 |
| 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 |
$1,001.40
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$1,418.65
|
| Rate for Payer: First Health Commercial |
$1,502.10
|
| Rate for Payer: First Health Workers Compensation |
$644.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,502.10
|
| Rate for Payer: GEHA Commercial |
$1,335.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,502.10
|
| 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 |
$1,518.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,168.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,502.10
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,585.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,251.75
|
| 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 |
$1,552.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$667.60
|
| 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 |
$455.64
|
|
|
CYSTO W/REMOVAL OF LESIONS SMALL
|
Facility
|
IP
|
$1,669.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
6152224
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$455.64 |
| Max. Negotiated Rate |
$1,585.55 |
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$1,418.65
|
| Rate for Payer: First Health Commercial |
$1,502.10
|
| Rate for Payer: First Health Workers Compensation |
$644.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,502.10
|
| Rate for Payer: GEHA Commercial |
$1,168.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,502.10
|
| Rate for Payer: Multiplan All |
$1,518.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,168.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,502.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,585.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,251.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,552.17
|
| Rate for Payer: Zelis Auto |
$667.60
|
| Rate for Payer: Zelis Worker's Compensation |
$455.64
|
|
|
CYSTO W/REMOVAL OF TUMORS SMALL
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
6152234
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$212.12 |
| Max. Negotiated Rate |
$738.15 |
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$660.45
|
| Rate for Payer: First Health Commercial |
$699.30
|
| Rate for Payer: First Health Workers Compensation |
$300.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$699.30
|
| Rate for Payer: GEHA Commercial |
$543.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$699.30
|
| Rate for Payer: Multiplan All |
$707.07
|
| Rate for Payer: OMNI Networks Commercial |
$543.90
|
| Rate for Payer: One Health Plan PPO/POS |
$699.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$738.15
|
| Rate for Payer: Three Rivers Provider Network All |
$582.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$722.61
|
| Rate for Payer: Zelis Auto |
$310.80
|
| Rate for Payer: Zelis Worker's Compensation |
$212.12
|
|
|
CYSTO W/REMOVAL OF TUMORS SMALL
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9200006
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$212.12 |
| 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 |
$466.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$660.45
|
| Rate for Payer: First Health Commercial |
$699.30
|
| Rate for Payer: First Health Workers Compensation |
$300.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$699.30
|
| Rate for Payer: GEHA Commercial |
$621.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$699.30
|
| 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 |
$707.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$543.90
|
| Rate for Payer: One Health Plan PPO/POS |
$699.30
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$738.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$582.75
|
| 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 |
$722.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$310.80
|
| 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 |
$212.12
|
|
|
CYSTO W/REMOVAL OF TUMORS SMALL
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9200006
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$212.12 |
| Max. Negotiated Rate |
$738.15 |
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$660.45
|
| Rate for Payer: First Health Commercial |
$699.30
|
| Rate for Payer: First Health Workers Compensation |
$300.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$699.30
|
| Rate for Payer: GEHA Commercial |
$543.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$699.30
|
| Rate for Payer: Multiplan All |
$707.07
|
| Rate for Payer: OMNI Networks Commercial |
$543.90
|
| Rate for Payer: One Health Plan PPO/POS |
$699.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$738.15
|
| Rate for Payer: Three Rivers Provider Network All |
$582.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$722.61
|
| Rate for Payer: Zelis Auto |
$310.80
|
| Rate for Payer: Zelis Worker's Compensation |
$212.12
|
|
|
CYSTO W/REMOVAL OF TUMORS SMALL
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
6152234
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$212.12 |
| 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 |
$466.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$660.45
|
| Rate for Payer: First Health Commercial |
$699.30
|
| Rate for Payer: First Health Workers Compensation |
$300.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$699.30
|
| Rate for Payer: GEHA Commercial |
$621.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$699.30
|
| 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 |
$707.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$543.90
|
| Rate for Payer: One Health Plan PPO/POS |
$699.30
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$738.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$582.75
|
| 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 |
$722.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$310.80
|
| 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 |
$212.12
|
|
|
CYSTO W/RENAL STRICTURE TX
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
CPT 52343
|
| Hospital Charge Code |
6152343
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.79 |
| 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 |
$535.80
|
| 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 |
$535.80
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cigna Commercial |
$759.05
|
| Rate for Payer: First Health Commercial |
$803.70
|
| Rate for Payer: First Health Workers Compensation |
$344.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$803.70
|
| Rate for Payer: GEHA Commercial |
$714.40
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$803.70
|
| 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 |
$812.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$625.10
|
| Rate for Payer: One Health Plan PPO/POS |
$803.70
|
| 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 |
$848.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$669.75
|
| 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 |
$830.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$357.20
|
| 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 |
$243.79
|
|
|
CYSTO W/RENAL STRICTURE TX
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
CPT 52343
|
| Hospital Charge Code |
6152343
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.79 |
| Max. Negotiated Rate |
$848.35 |
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cigna Commercial |
$759.05
|
| Rate for Payer: First Health Commercial |
$803.70
|
| Rate for Payer: First Health Workers Compensation |
$344.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$803.70
|
| Rate for Payer: GEHA Commercial |
$625.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$803.70
|
| Rate for Payer: Multiplan All |
$812.63
|
| Rate for Payer: OMNI Networks Commercial |
$625.10
|
| Rate for Payer: One Health Plan PPO/POS |
$803.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$848.35
|
| Rate for Payer: Three Rivers Provider Network All |
$669.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$830.49
|
| Rate for Payer: Zelis Auto |
$357.20
|
| Rate for Payer: Zelis Worker's Compensation |
$243.79
|
|
|
CYSTO W/UP STRICTURE TX
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
CPT 52342
|
| Hospital Charge Code |
6152342
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$218.95 |
| 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 |
$481.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Cigna Commercial |
$681.70
|
| Rate for Payer: First Health Commercial |
$721.80
|
| Rate for Payer: First Health Workers Compensation |
$309.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$721.80
|
| Rate for Payer: GEHA Commercial |
$641.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$721.80
|
| 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 |
$729.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$561.40
|
| Rate for Payer: One Health Plan PPO/POS |
$721.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$761.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$601.50
|
| 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 |
$745.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$320.80
|
| 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 |
$218.95
|
|
|
CYSTO W/UP STRICTURE TX
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
CPT 52342
|
| Hospital Charge Code |
6152342
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$218.95 |
| Max. Negotiated Rate |
$761.90 |
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Cigna Commercial |
$681.70
|
| Rate for Payer: First Health Commercial |
$721.80
|
| Rate for Payer: First Health Workers Compensation |
$309.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$721.80
|
| Rate for Payer: GEHA Commercial |
$561.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$721.80
|
| Rate for Payer: Multiplan All |
$729.82
|
| Rate for Payer: OMNI Networks Commercial |
$561.40
|
| Rate for Payer: One Health Plan PPO/POS |
$721.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$761.90
|
| Rate for Payer: Three Rivers Provider Network All |
$601.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$745.86
|
| Rate for Payer: Zelis Auto |
$320.80
|
| Rate for Payer: Zelis Worker's Compensation |
$218.95
|
|
|
CYSTO W/URETER STRICTURE TX
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 52341
|
| Hospital Charge Code |
6152341
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$201.20 |
| 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 |
$442.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cigna Commercial |
$626.45
|
| Rate for Payer: First Health Commercial |
$663.30
|
| Rate for Payer: First Health Workers Compensation |
$284.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$663.30
|
| Rate for Payer: GEHA Commercial |
$589.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$663.30
|
| 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 |
$670.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$515.90
|
| Rate for Payer: One Health Plan PPO/POS |
$663.30
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$700.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$552.75
|
| 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 |
$685.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$294.80
|
| 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 |
$201.20
|
|
|
CYSTO W/URETER STRICTURE TX
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 52341
|
| Hospital Charge Code |
6152341
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$700.15 |
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cigna Commercial |
$626.45
|
| Rate for Payer: First Health Commercial |
$663.30
|
| Rate for Payer: First Health Workers Compensation |
$284.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$663.30
|
| Rate for Payer: GEHA Commercial |
$515.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$663.30
|
| Rate for Payer: Multiplan All |
$670.67
|
| Rate for Payer: OMNI Networks Commercial |
$515.90
|
| Rate for Payer: One Health Plan PPO/POS |
$663.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$700.15
|
| Rate for Payer: Three Rivers Provider Network All |
$552.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$685.41
|
| Rate for Payer: Zelis Auto |
$294.80
|
| Rate for Payer: Zelis Worker's Compensation |
$201.20
|
|
|
CYTO CONC TECH SMEAR/INTERP
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
2299069
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$81.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Worker's Compensation |
$57.60
|
|
|
CYTO CONC TECH SMEAR/INTERP
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
2299069
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$49.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$37.27
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$81.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: GEHA Medicare |
$37.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$41.00
|
| Rate for Payer: Humana Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$62.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$50.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$37.27
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$63.36
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$58.81
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$50.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$37.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$74.54
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.52
|
| Rate for Payer: United Healthcare Commercial |
$181.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$37.27
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Medicare |
$31.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$44.72
|
| Rate for Payer: Zelis Worker's Compensation |
$57.60
|
|
|
CYTOLOGY ASPIRATION INTER AND REPORT
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
2299071
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$134.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$134.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$106.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$50.73
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cigna Commercial |
$264.35
|
| Rate for Payer: First Health Commercial |
$279.90
|
| Rate for Payer: First Health Workers Compensation |
$183.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.90
|
| Rate for Payer: GEHA Commercial |
$248.80
|
| Rate for Payer: GEHA Medicare |
$50.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.90
|
| Rate for Payer: Humana ChoiceCare |
$55.80
|
| Rate for Payer: Humana Medicare Advantage |
$50.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$85.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$108.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$50.73
|
| Rate for Payer: Multiplan All |
$283.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$86.24
|
| Rate for Payer: OMNI Networks Commercial |
$217.70
|
| Rate for Payer: One Health Plan PPO/POS |
$279.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$125.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$108.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$50.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$295.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$101.46
|
| Rate for Payer: Three Rivers Provider Network All |
$233.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$49.72
|
| Rate for Payer: United Healthcare Commercial |
$264.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$108.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$289.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$50.73
|
| Rate for Payer: Zelis Auto |
$124.40
|
| Rate for Payer: Zelis Medicare |
$43.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$60.88
|
| Rate for Payer: Zelis Worker's Compensation |
$129.87
|
|
|
CYTOLOGY ASPIRATION INTER AND REPORT
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
2299071
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cigna Commercial |
$264.35
|
| Rate for Payer: First Health Commercial |
$279.90
|
| Rate for Payer: First Health Workers Compensation |
$183.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.90
|
| Rate for Payer: GEHA Commercial |
$217.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.90
|
| Rate for Payer: Multiplan All |
$283.01
|
| Rate for Payer: OMNI Networks Commercial |
$217.70
|
| Rate for Payer: One Health Plan PPO/POS |
$279.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$295.45
|
| Rate for Payer: Three Rivers Provider Network All |
$233.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$289.23
|
| Rate for Payer: Zelis Auto |
$124.40
|
| Rate for Payer: Zelis Worker's Compensation |
$129.87
|
|
|
cytology fluid Ameripath Lub
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
2299065
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$65.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$65.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$52.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$37.27
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$79.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$156.80
|
| Rate for Payer: GEHA Medicare |
$37.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Humana ChoiceCare |
$41.00
|
| Rate for Payer: Humana Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$62.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$53.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$37.27
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$63.36
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$61.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$53.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$37.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$74.54
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.52
|
| Rate for Payer: United Healthcare Commercial |
$166.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$37.27
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Medicare |
$31.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$44.72
|
| Rate for Payer: Zelis Worker's Compensation |
$56.12
|
|
|
cytology fluid Ameripath Lub
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
2299065
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$56.12 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$79.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$137.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Worker's Compensation |
$56.12
|
|
|
CYTOMEGALOVIRUS IMMUNE GLOB 2.5 GM/50 ML
|
Facility
|
OP
|
$6,042.00
|
|
|
Service Code
|
CPT J0850
|
| Hospital Charge Code |
3303056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,204.78 |
| Max. Negotiated Rate |
$5,739.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,520.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,625.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,520.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,204.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,808.65
|
| Rate for Payer: Cash Price |
$3,625.20
|
| Rate for Payer: Cash Price |
$3,625.20
|
| Rate for Payer: Cigna Commercial |
$5,135.70
|
| Rate for Payer: First Health Commercial |
$5,437.80
|
| Rate for Payer: First Health Workers Compensation |
$2,332.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,437.80
|
| Rate for Payer: GEHA Commercial |
$1,989.52
|
| Rate for Payer: GEHA Medicare |
$1,808.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,437.80
|
| Rate for Payer: Humana ChoiceCare |
$1,989.52
|
| Rate for Payer: Humana Medicare Advantage |
$1,808.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,038.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,229.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,808.65
|
| Rate for Payer: Multiplan All |
$5,498.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,074.70
|
| Rate for Payer: OMNI Networks Commercial |
$4,229.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,437.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,419.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,229.32
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,808.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,739.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,617.30
|
| Rate for Payer: Three Rivers Provider Network All |
$4,531.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,772.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,229.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,808.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,619.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,808.65
|
| Rate for Payer: Zelis Auto |
$2,416.80
|
| Rate for Payer: Zelis Medicare |
$1,537.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,170.38
|
| Rate for Payer: Zelis Worker's Compensation |
$1,649.47
|
|
|
CYTOMEGALOVIRUS IMMUNE GLOB 2.5 GM/50 ML
|
Facility
|
IP
|
$6,042.00
|
|
|
Service Code
|
CPT J0850
|
| Hospital Charge Code |
3303056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,649.47 |
| Max. Negotiated Rate |
$5,739.90 |
| Rate for Payer: Cash Price |
$3,625.20
|
| Rate for Payer: Cigna Commercial |
$5,135.70
|
| Rate for Payer: First Health Commercial |
$5,437.80
|
| Rate for Payer: First Health Workers Compensation |
$2,332.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,437.80
|
| Rate for Payer: GEHA Commercial |
$4,229.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,437.80
|
| Rate for Payer: Multiplan All |
$5,498.22
|
| Rate for Payer: OMNI Networks Commercial |
$4,229.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,437.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,739.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,531.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,619.06
|
| Rate for Payer: Zelis Auto |
$2,416.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,649.47
|
|
