|
DILATION OF ANAL SPHINCTER
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
6145905
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$142.78 |
| Max. Negotiated Rate |
$2,423.61 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$313.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,142.50
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cigna Commercial |
$444.55
|
| Rate for Payer: First Health Commercial |
$470.70
|
| Rate for Payer: First Health Workers Compensation |
$201.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$470.70
|
| Rate for Payer: GEHA Commercial |
$418.40
|
| Rate for Payer: GEHA Medicare |
$1,142.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$470.70
|
| Rate for Payer: Humana ChoiceCare |
$1,256.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,142.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,919.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,142.50
|
| Rate for Payer: Multiplan All |
$475.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.25
|
| Rate for Payer: OMNI Networks Commercial |
$366.10
|
| Rate for Payer: One Health Plan PPO/POS |
$470.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,142.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$496.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,285.00
|
| Rate for Payer: Three Rivers Provider Network All |
$392.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,119.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,142.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$486.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,142.50
|
| Rate for Payer: Zelis Auto |
$209.20
|
| Rate for Payer: Zelis Medicare |
$971.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,371.00
|
| Rate for Payer: Zelis Worker's Compensation |
$142.78
|
|
|
DILATION OF ANAL SPHINCTER
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
6145905
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$142.78 |
| Max. Negotiated Rate |
$496.85 |
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cigna Commercial |
$444.55
|
| Rate for Payer: First Health Commercial |
$470.70
|
| Rate for Payer: First Health Workers Compensation |
$201.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$470.70
|
| Rate for Payer: GEHA Commercial |
$366.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$470.70
|
| Rate for Payer: Multiplan All |
$475.93
|
| Rate for Payer: OMNI Networks Commercial |
$366.10
|
| Rate for Payer: One Health Plan PPO/POS |
$470.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$496.85
|
| Rate for Payer: Three Rivers Provider Network All |
$392.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$486.39
|
| Rate for Payer: Zelis Auto |
$209.20
|
| Rate for Payer: Zelis Worker's Compensation |
$142.78
|
|
|
DILATION OF CERVICAL CANAL
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
6157800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$6,161.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$88.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.90
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$125.80
|
| Rate for Payer: First Health Commercial |
$133.20
|
| Rate for Payer: First Health Workers Compensation |
$57.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$133.20
|
| Rate for Payer: GEHA Commercial |
$118.40
|
| Rate for Payer: GEHA Medicare |
$3,080.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$133.20
|
| Rate for Payer: Humana ChoiceCare |
$3,388.99
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.90
|
| Rate for Payer: Multiplan All |
$134.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.53
|
| Rate for Payer: OMNI Networks Commercial |
$103.60
|
| Rate for Payer: One Health Plan PPO/POS |
$133.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$140.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.80
|
| Rate for Payer: Three Rivers Provider Network All |
$111.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$137.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.90
|
| Rate for Payer: Zelis Auto |
$59.20
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.08
|
| Rate for Payer: Zelis Worker's Compensation |
$40.40
|
|
|
DILATION OF CERVICAL CANAL
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
6157800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$125.80
|
| Rate for Payer: First Health Commercial |
$133.20
|
| Rate for Payer: First Health Workers Compensation |
$57.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$133.20
|
| Rate for Payer: GEHA Commercial |
$103.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$133.20
|
| Rate for Payer: Multiplan All |
$134.68
|
| Rate for Payer: OMNI Networks Commercial |
$103.60
|
| Rate for Payer: One Health Plan PPO/POS |
$133.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$140.60
|
| Rate for Payer: Three Rivers Provider Network All |
$111.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$137.64
|
| Rate for Payer: Zelis Auto |
$59.20
|
| Rate for Payer: Zelis Worker's Compensation |
$40.40
|
|
|
DILATION OF RECTAL NARROWING
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
6145910
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$164.07 |
| Max. Negotiated Rate |
$2,423.61 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$360.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,142.50
|
| Rate for Payer: Cash Price |
$360.60
|
| Rate for Payer: Cash Price |
$360.60
|
| Rate for Payer: Cigna Commercial |
$510.85
|
| Rate for Payer: First Health Commercial |
$540.90
|
| Rate for Payer: First Health Workers Compensation |
$232.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$540.90
|
| Rate for Payer: GEHA Commercial |
$480.80
|
| Rate for Payer: GEHA Medicare |
$1,142.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$540.90
|
| Rate for Payer: Humana ChoiceCare |
$1,256.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,142.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,919.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,142.50
|
| Rate for Payer: Multiplan All |
$546.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.25
|
| Rate for Payer: OMNI Networks Commercial |
$420.70
|
| Rate for Payer: One Health Plan PPO/POS |
$540.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,142.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$570.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,285.00
|
| Rate for Payer: Three Rivers Provider Network All |
$450.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,119.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,142.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$558.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,142.50
|
| Rate for Payer: Zelis Auto |
$240.40
|
| Rate for Payer: Zelis Medicare |
$971.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,371.00
|
| Rate for Payer: Zelis Worker's Compensation |
$164.07
|
|
|
DILATION OF RECTAL NARROWING
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
6145910
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$164.07 |
| Max. Negotiated Rate |
$570.95 |
| Rate for Payer: Cash Price |
$360.60
|
| Rate for Payer: Cigna Commercial |
$510.85
|
| Rate for Payer: First Health Commercial |
$540.90
|
| Rate for Payer: First Health Workers Compensation |
$232.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$540.90
|
| Rate for Payer: GEHA Commercial |
$420.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$540.90
|
| Rate for Payer: Multiplan All |
$546.91
|
| Rate for Payer: OMNI Networks Commercial |
$420.70
|
| Rate for Payer: One Health Plan PPO/POS |
$540.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$570.95
|
| Rate for Payer: Three Rivers Provider Network All |
$450.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$558.93
|
| Rate for Payer: Zelis Auto |
$240.40
|
| Rate for Payer: Zelis Worker's Compensation |
$164.07
|
|
|
DILATION OF SALIVARY DUCT
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 42650
|
| Hospital Charge Code |
6142650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$127.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
DILATION OF SALIVARY DUCT
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 42650
|
| Hospital Charge Code |
6142650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$2,870.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,435.33
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: GEHA Medicare |
$1,435.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Humana ChoiceCare |
$1,578.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,411.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,435.33
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,440.06
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,435.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,870.66
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,406.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,435.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,435.33
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Medicare |
$1,220.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,722.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
DILATION OF SALIVARY DUCT
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
6142660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$238.85
|
| Rate for Payer: First Health Commercial |
$252.90
|
| Rate for Payer: First Health Workers Compensation |
$108.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.90
|
| Rate for Payer: GEHA Commercial |
$196.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.90
|
| Rate for Payer: Multiplan All |
$255.71
|
| Rate for Payer: OMNI Networks Commercial |
$196.70
|
| Rate for Payer: One Health Plan PPO/POS |
$252.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.95
|
| Rate for Payer: Three Rivers Provider Network All |
$210.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$261.33
|
| Rate for Payer: Zelis Auto |
$112.40
|
| Rate for Payer: Zelis Worker's Compensation |
$76.71
|
|
|
DILATION OF SALIVARY DUCT
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
6142660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$986.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$493.45
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$238.85
|
| Rate for Payer: First Health Commercial |
$252.90
|
| Rate for Payer: First Health Workers Compensation |
$108.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.90
|
| Rate for Payer: GEHA Commercial |
$224.80
|
| Rate for Payer: GEHA Medicare |
$493.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.90
|
| Rate for Payer: Humana ChoiceCare |
$542.79
|
| Rate for Payer: Humana Medicare Advantage |
$493.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$829.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$493.45
|
| Rate for Payer: Multiplan All |
$255.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$838.87
|
| Rate for Payer: OMNI Networks Commercial |
$196.70
|
| Rate for Payer: One Health Plan PPO/POS |
$252.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$493.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$986.90
|
| Rate for Payer: Three Rivers Provider Network All |
$210.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$483.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$493.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$261.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$493.45
|
| Rate for Payer: Zelis Auto |
$112.40
|
| Rate for Payer: Zelis Medicare |
$419.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$592.14
|
| Rate for Payer: Zelis Worker's Compensation |
$76.71
|
|
|
DILATION OF URETHRA
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 53665
|
| Hospital Charge Code |
6153665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$46.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$84.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Worker's Compensation |
$33.03
|
|
|
DILATION OF URETHRA
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 53665
|
| Hospital Charge Code |
6153665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$3,969.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,984.97
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$46.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$96.80
|
| Rate for Payer: GEHA Medicare |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Humana ChoiceCare |
$2,183.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,984.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,334.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Medicare |
$1,687.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,381.96
|
| Rate for Payer: Zelis Worker's Compensation |
$33.03
|
|
|
DILATION OF VAGINA
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 57400
|
| Hospital Charge Code |
6157400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$113.02 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$351.90
|
| Rate for Payer: First Health Commercial |
$372.60
|
| Rate for Payer: First Health Workers Compensation |
$159.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$372.60
|
| Rate for Payer: GEHA Commercial |
$289.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$372.60
|
| Rate for Payer: Multiplan All |
$376.74
|
| Rate for Payer: OMNI Networks Commercial |
$289.80
|
| Rate for Payer: One Health Plan PPO/POS |
$372.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$393.30
|
| Rate for Payer: Three Rivers Provider Network All |
$310.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$385.02
|
| Rate for Payer: Zelis Auto |
$165.60
|
| Rate for Payer: Zelis Worker's Compensation |
$113.02
|
|
|
DILATION OF VAGINA
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 57400
|
| Hospital Charge Code |
6157400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$113.02 |
| Max. Negotiated Rate |
$6,161.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$248.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.90
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$351.90
|
| Rate for Payer: First Health Commercial |
$372.60
|
| Rate for Payer: First Health Workers Compensation |
$159.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$372.60
|
| Rate for Payer: GEHA Commercial |
$331.20
|
| Rate for Payer: GEHA Medicare |
$3,080.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$372.60
|
| Rate for Payer: Humana ChoiceCare |
$3,388.99
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.90
|
| Rate for Payer: Multiplan All |
$376.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.53
|
| Rate for Payer: OMNI Networks Commercial |
$289.80
|
| Rate for Payer: One Health Plan PPO/POS |
$372.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$393.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.80
|
| Rate for Payer: Three Rivers Provider Network All |
$310.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$385.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.90
|
| Rate for Payer: Zelis Auto |
$165.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.08
|
| Rate for Payer: Zelis Worker's Compensation |
$113.02
|
|
|
DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
9200008
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$97.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$176.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Worker's Compensation |
$68.80
|
|
|
DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
9200008
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$471.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$235.67
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$97.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: GEHA Medicare |
$235.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Humana ChoiceCare |
$259.24
|
| Rate for Payer: Humana Medicare Advantage |
$235.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$395.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$246.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$235.67
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$400.64
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$285.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$246.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$235.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$471.34
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$230.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$235.67
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Medicare |
$200.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$282.80
|
| Rate for Payer: Zelis Worker's Compensation |
$68.80
|
|
|
DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
6153600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$97.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$176.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Worker's Compensation |
$68.80
|
|
|
DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
6153600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$471.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$235.67
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$97.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: GEHA Medicare |
$235.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Humana ChoiceCare |
$259.24
|
| Rate for Payer: Humana Medicare Advantage |
$235.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$395.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$246.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$235.67
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$400.64
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$285.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$246.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$235.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$471.34
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$230.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$235.67
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Medicare |
$200.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$282.80
|
| Rate for Payer: Zelis Worker's Compensation |
$68.80
|
|
|
DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
9200009
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$249.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$206.55
|
| Rate for Payer: First Health Commercial |
$218.70
|
| Rate for Payer: First Health Workers Compensation |
$93.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$218.70
|
| Rate for Payer: GEHA Commercial |
$194.40
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$218.70
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$221.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$170.10
|
| Rate for Payer: One Health Plan PPO/POS |
$218.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$230.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$182.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$97.20
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$66.34
|
|
|
DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
6153601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$206.55
|
| Rate for Payer: First Health Commercial |
$218.70
|
| Rate for Payer: First Health Workers Compensation |
$93.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$218.70
|
| Rate for Payer: GEHA Commercial |
$170.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$218.70
|
| Rate for Payer: Multiplan All |
$221.13
|
| Rate for Payer: OMNI Networks Commercial |
$170.10
|
| Rate for Payer: One Health Plan PPO/POS |
$218.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$230.85
|
| Rate for Payer: Three Rivers Provider Network All |
$182.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.99
|
| Rate for Payer: Zelis Auto |
$97.20
|
| Rate for Payer: Zelis Worker's Compensation |
$66.34
|
|
|
DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
9200009
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$206.55
|
| Rate for Payer: First Health Commercial |
$218.70
|
| Rate for Payer: First Health Workers Compensation |
$93.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$218.70
|
| Rate for Payer: GEHA Commercial |
$170.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$218.70
|
| Rate for Payer: Multiplan All |
$221.13
|
| Rate for Payer: OMNI Networks Commercial |
$170.10
|
| Rate for Payer: One Health Plan PPO/POS |
$218.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$230.85
|
| Rate for Payer: Three Rivers Provider Network All |
$182.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.99
|
| Rate for Payer: Zelis Auto |
$97.20
|
| Rate for Payer: Zelis Worker's Compensation |
$66.34
|
|
|
DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
6153601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$249.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$206.55
|
| Rate for Payer: First Health Commercial |
$218.70
|
| Rate for Payer: First Health Workers Compensation |
$93.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$218.70
|
| Rate for Payer: GEHA Commercial |
$194.40
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$218.70
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$221.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$170.10
|
| Rate for Payer: One Health Plan PPO/POS |
$218.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$230.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$182.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$97.20
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$66.34
|
|
|
DILAT URTHRL STRIX FILFRM&FLLWR MALE 1ST
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 53620
|
| Hospital Charge Code |
6153620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.08 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.08
|
|
|
DILAT URTHRL STRIX FILFRM&FLLWR MALE 1ST
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 53620
|
| Hospital Charge Code |
6153620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.08 |
| Max. Negotiated Rate |
$2,024.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,024.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,024.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,603.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$646.77
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: GEHA Medicare |
$646.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$711.45
|
| Rate for Payer: Humana Medicare Advantage |
$646.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,086.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,636.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$646.77
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,099.51
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,889.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,636.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$646.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,293.54
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$633.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,636.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$646.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$646.77
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Medicare |
$549.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$776.12
|
| Rate for Payer: Zelis Worker's Compensation |
$75.08
|
|
|
DILAT URTHRL STRIX FILFRM&FLLWR MALE 1ST
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 53620
|
| Hospital Charge Code |
8900016
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$2,024.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,024.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$242.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,024.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,603.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$646.77
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$323.20
|
| Rate for Payer: GEHA Medicare |
$646.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Humana ChoiceCare |
$711.45
|
| Rate for Payer: Humana Medicare Advantage |
$646.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,086.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,636.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$646.77
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,099.51
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,889.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,636.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$646.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,293.54
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$633.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,636.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$646.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$646.77
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Medicare |
$549.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$776.12
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
