|
KIDNEY ENDOSCOPY
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 50553
|
| Hospital Charge Code |
6150553
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$767.60 |
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$565.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: Zelis Auto |
$323.20
|
| Rate for Payer: Zelis Worker's Compensation |
$220.58
|
|
|
KIDNEY ENDOSCOPY
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 50572
|
| Hospital Charge Code |
6150572
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$301.67 |
| Max. Negotiated Rate |
$1,049.75 |
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cigna Commercial |
$939.25
|
| Rate for Payer: First Health Commercial |
$994.50
|
| Rate for Payer: First Health Workers Compensation |
$426.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$994.50
|
| Rate for Payer: GEHA Commercial |
$773.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$994.50
|
| Rate for Payer: Multiplan All |
$1,005.55
|
| Rate for Payer: OMNI Networks Commercial |
$773.50
|
| Rate for Payer: One Health Plan PPO/POS |
$994.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,049.75
|
| Rate for Payer: Three Rivers Provider Network All |
$828.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,027.65
|
| Rate for Payer: Zelis Auto |
$442.00
|
| Rate for Payer: Zelis Worker's Compensation |
$301.67
|
|
|
KIDNEY ENDOSCOPY
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 50575
|
| Hospital Charge Code |
6150575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$405.40 |
| Max. Negotiated Rate |
$1,410.75 |
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cigna Commercial |
$1,262.25
|
| Rate for Payer: First Health Commercial |
$1,336.50
|
| Rate for Payer: First Health Workers Compensation |
$573.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,336.50
|
| Rate for Payer: GEHA Commercial |
$1,039.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,336.50
|
| Rate for Payer: Multiplan All |
$1,351.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,039.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,336.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,410.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,113.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,381.05
|
| Rate for Payer: Zelis Auto |
$594.00
|
| Rate for Payer: Zelis Worker's Compensation |
$405.40
|
|
|
KIDNEY ENDOSCOPY
|
Facility
|
OP
|
$1,022.00
|
|
|
Service Code
|
CPT 50570
|
| Hospital Charge Code |
6150570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$279.01 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$613.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$571.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$868.70
|
| Rate for Payer: First Health Commercial |
$919.80
|
| Rate for Payer: First Health Workers Compensation |
$394.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$919.80
|
| Rate for Payer: GEHA Commercial |
$817.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$919.80
|
| 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 |
$583.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$930.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$715.40
|
| Rate for Payer: One Health Plan PPO/POS |
$919.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$673.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$583.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$970.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$766.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$950.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$408.80
|
| 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 |
$279.01
|
|
|
KIDNEY ENDOSCOPY
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
6150551
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$208.57 |
| Max. Negotiated Rate |
$725.80 |
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cigna Commercial |
$649.40
|
| Rate for Payer: First Health Commercial |
$687.60
|
| Rate for Payer: First Health Workers Compensation |
$294.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$687.60
|
| Rate for Payer: GEHA Commercial |
$534.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$687.60
|
| Rate for Payer: Multiplan All |
$695.24
|
| Rate for Payer: OMNI Networks Commercial |
$534.80
|
| Rate for Payer: One Health Plan PPO/POS |
$687.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$725.80
|
| Rate for Payer: Three Rivers Provider Network All |
$573.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$710.52
|
| Rate for Payer: Zelis Auto |
$305.60
|
| Rate for Payer: Zelis Worker's Compensation |
$208.57
|
|
|
KIDNEY ENDOSCOPY
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 50553
|
| Hospital Charge Code |
6150553
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$484.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$646.40
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$323.20
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$220.58
|
|
|
KIDNEY ENDOSCOPY
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 50575
|
| Hospital Charge Code |
6150575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$405.40 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$891.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,899.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cigna Commercial |
$1,262.25
|
| Rate for Payer: First Health Commercial |
$1,336.50
|
| Rate for Payer: First Health Workers Compensation |
$573.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,336.50
|
| Rate for Payer: GEHA Commercial |
$1,188.00
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,336.50
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,958.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,351.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,039.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,336.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,416.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,958.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,410.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,113.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,958.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,381.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$594.00
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$405.40
|
|
|
KIDNEY ENDOSCOPY
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 50572
|
| Hospital Charge Code |
6150572
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$301.67 |
| Max. Negotiated Rate |
$1,267.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$663.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$571.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cigna Commercial |
$939.25
|
| Rate for Payer: First Health Commercial |
$994.50
|
| Rate for Payer: First Health Workers Compensation |
$426.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$994.50
|
| Rate for Payer: GEHA Commercial |
$884.00
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$994.50
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$583.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$1,005.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$773.50
|
| Rate for Payer: One Health Plan PPO/POS |
$994.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$673.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$583.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,049.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$828.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,027.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$442.00
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$301.67
|
|
|
KIDNEY ENDOSCOPY & BIOPSY
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
CPT 50574
|
| Hospital Charge Code |
6150574
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$320.77 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$705.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$571.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$998.75
|
| Rate for Payer: First Health Commercial |
$1,057.50
|
| Rate for Payer: First Health Workers Compensation |
$453.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,057.50
|
| Rate for Payer: GEHA Commercial |
$940.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,057.50
|
| 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 |
$583.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,069.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$822.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,057.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$673.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$583.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,116.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$881.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,092.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$470.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$320.77
|
|
|
KIDNEY ENDOSCOPY & BIOPSY
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
CPT 50574
|
| Hospital Charge Code |
6150574
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$320.77 |
| Max. Negotiated Rate |
$1,116.25 |
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$998.75
|
| Rate for Payer: First Health Commercial |
$1,057.50
|
| Rate for Payer: First Health Workers Compensation |
$453.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,057.50
|
| Rate for Payer: GEHA Commercial |
$822.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,057.50
|
| Rate for Payer: Multiplan All |
$1,069.25
|
| Rate for Payer: OMNI Networks Commercial |
$822.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,057.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,116.25
|
| Rate for Payer: Three Rivers Provider Network All |
$881.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,092.75
|
| Rate for Payer: Zelis Auto |
$470.00
|
| Rate for Payer: Zelis Worker's Compensation |
$320.77
|
|
|
KIDNEY ENDOSCOPY & BIOPSY
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
CPT 50555
|
| Hospital Charge Code |
6150555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$241.06 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$750.55
|
| Rate for Payer: First Health Commercial |
$794.70
|
| Rate for Payer: First Health Workers Compensation |
$340.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$794.70
|
| Rate for Payer: GEHA Commercial |
$618.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$794.70
|
| Rate for Payer: Multiplan All |
$803.53
|
| Rate for Payer: OMNI Networks Commercial |
$618.10
|
| Rate for Payer: One Health Plan PPO/POS |
$794.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$838.85
|
| Rate for Payer: Three Rivers Provider Network All |
$662.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$821.19
|
| Rate for Payer: Zelis Auto |
$353.20
|
| Rate for Payer: Zelis Worker's Compensation |
$241.06
|
|
|
KIDNEY ENDOSCOPY & BIOPSY
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT 50555
|
| Hospital Charge Code |
6150555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$241.06 |
| Max. Negotiated Rate |
$17,561.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$529.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$721.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$571.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8,780.54
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$750.55
|
| Rate for Payer: First Health Commercial |
$794.70
|
| Rate for Payer: First Health Workers Compensation |
$340.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$794.70
|
| Rate for Payer: GEHA Commercial |
$706.40
|
| Rate for Payer: GEHA Medicare |
$8,780.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$794.70
|
| Rate for Payer: Humana ChoiceCare |
$9,658.59
|
| Rate for Payer: Humana Medicare Advantage |
$8,780.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14,751.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$583.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,780.54
|
| Rate for Payer: Multiplan All |
$803.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14,926.92
|
| Rate for Payer: OMNI Networks Commercial |
$618.10
|
| Rate for Payer: One Health Plan PPO/POS |
$794.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$673.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$583.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8,780.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$838.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17,561.08
|
| Rate for Payer: Three Rivers Provider Network All |
$662.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,604.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,780.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$821.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8,780.54
|
| Rate for Payer: Zelis Auto |
$353.20
|
| Rate for Payer: Zelis Medicare |
$7,463.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,536.65
|
| Rate for Payer: Zelis Worker's Compensation |
$241.06
|
|
|
KIDNEY ENDOSCOPY & TREATMENT
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT 50561
|
| Hospital Charge Code |
6150561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.13 |
| Max. Negotiated Rate |
$779.95 |
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$697.85
|
| Rate for Payer: First Health Commercial |
$738.90
|
| Rate for Payer: First Health Workers Compensation |
$316.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.90
|
| Rate for Payer: GEHA Commercial |
$574.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.90
|
| Rate for Payer: Multiplan All |
$747.11
|
| Rate for Payer: OMNI Networks Commercial |
$574.70
|
| Rate for Payer: One Health Plan PPO/POS |
$738.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.95
|
| Rate for Payer: Three Rivers Provider Network All |
$615.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$763.53
|
| Rate for Payer: Zelis Auto |
$328.40
|
| Rate for Payer: Zelis Worker's Compensation |
$224.13
|
|
|
KIDNEY ENDOSCOPY & TREATMENT
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
CPT 50576
|
| Hospital Charge Code |
6150576
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$320.77 |
| Max. Negotiated Rate |
$17,561.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,722.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$705.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,722.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,364.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8,780.54
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$998.75
|
| Rate for Payer: First Health Commercial |
$1,057.50
|
| Rate for Payer: First Health Workers Compensation |
$453.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,057.50
|
| Rate for Payer: GEHA Commercial |
$940.00
|
| Rate for Payer: GEHA Medicare |
$8,780.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,057.50
|
| Rate for Payer: Humana ChoiceCare |
$9,658.59
|
| Rate for Payer: Humana Medicare Advantage |
$8,780.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14,751.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,780.54
|
| Rate for Payer: Multiplan All |
$1,069.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14,926.92
|
| Rate for Payer: OMNI Networks Commercial |
$822.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,057.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,607.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8,780.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,116.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17,561.08
|
| Rate for Payer: Three Rivers Provider Network All |
$881.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,604.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,780.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,092.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8,780.54
|
| Rate for Payer: Zelis Auto |
$470.00
|
| Rate for Payer: Zelis Medicare |
$7,463.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,536.65
|
| Rate for Payer: Zelis Worker's Compensation |
$320.77
|
|
|
KIDNEY ENDOSCOPY & TREATMENT
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
CPT 50576
|
| Hospital Charge Code |
6150576
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$320.77 |
| Max. Negotiated Rate |
$1,116.25 |
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$998.75
|
| Rate for Payer: First Health Commercial |
$1,057.50
|
| Rate for Payer: First Health Workers Compensation |
$453.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,057.50
|
| Rate for Payer: GEHA Commercial |
$822.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,057.50
|
| Rate for Payer: Multiplan All |
$1,069.25
|
| Rate for Payer: OMNI Networks Commercial |
$822.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,057.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,116.25
|
| Rate for Payer: Three Rivers Provider Network All |
$881.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,092.75
|
| Rate for Payer: Zelis Auto |
$470.00
|
| Rate for Payer: Zelis Worker's Compensation |
$320.77
|
|
|
KIDNEY ENDOSCOPY & TREATMENT
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 50557
|
| Hospital Charge Code |
6150557
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.15 |
| Max. Negotiated Rate |
$17,561.08 |
| 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 |
$538.80
|
| 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 |
$8,780.54
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: First Health Workers Compensation |
$346.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: GEHA Medicare |
$8,780.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$9,658.59
|
| Rate for Payer: Humana Medicare Advantage |
$8,780.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14,751.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,780.54
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14,926.92
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8,780.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17,561.08
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,604.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,780.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8,780.54
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Medicare |
$7,463.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,536.65
|
| Rate for Payer: Zelis Worker's Compensation |
$245.15
|
|
|
KIDNEY ENDOSCOPY & TREATMENT
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT 50580
|
| Hospital Charge Code |
6150580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.62 |
| Max. Negotiated Rate |
$1,202.70 |
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,076.10
|
| Rate for Payer: First Health Commercial |
$1,139.40
|
| Rate for Payer: First Health Workers Compensation |
$488.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,139.40
|
| Rate for Payer: GEHA Commercial |
$886.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,139.40
|
| Rate for Payer: Multiplan All |
$1,152.06
|
| Rate for Payer: OMNI Networks Commercial |
$886.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,139.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,202.70
|
| Rate for Payer: Three Rivers Provider Network All |
$949.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,177.38
|
| Rate for Payer: Zelis Auto |
$506.40
|
| Rate for Payer: Zelis Worker's Compensation |
$345.62
|
|
|
KIDNEY ENDOSCOPY & TREATMENT
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 50557
|
| Hospital Charge Code |
6150557
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.15 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: First Health Workers Compensation |
$346.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Worker's Compensation |
$245.15
|
|
|
KIDNEY ENDOSCOPY & TREATMENT
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT 50580
|
| Hospital Charge Code |
6150580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.62 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,722.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$759.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,722.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,364.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,076.10
|
| Rate for Payer: First Health Commercial |
$1,139.40
|
| Rate for Payer: First Health Workers Compensation |
$488.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,139.40
|
| Rate for Payer: GEHA Commercial |
$1,012.80
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,139.40
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,152.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$886.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,139.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,607.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,202.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$949.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,177.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$506.40
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$345.62
|
|
|
KIDNEY ENDOSCOPY & TREATMENT
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 50561
|
| Hospital Charge Code |
6150561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.13 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$492.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$697.85
|
| Rate for Payer: First Health Commercial |
$738.90
|
| Rate for Payer: First Health Workers Compensation |
$316.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.90
|
| Rate for Payer: GEHA Commercial |
$656.80
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.90
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$747.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$574.70
|
| Rate for Payer: One Health Plan PPO/POS |
$738.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$615.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$763.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$328.40
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$224.13
|
|
|
KIRSCHNER WIRE 0.045"X15"
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$79.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Humana ChoiceCare |
$25.74
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.40
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$87.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: Zelis Auto |
$39.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$49.50
|
|
|
KIRSCHNER WIRE 0.045"X15"
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.20
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$69.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: Zelis Auto |
$39.60
|
|
|
KIT CAP PERSONALIZED KNEE SYSTEM
|
Facility
|
IP
|
$15,834.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,333.60 |
| Max. Negotiated Rate |
$15,042.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,667.20
|
| Rate for Payer: Cash Price |
$9,500.40
|
| Rate for Payer: Cash Price |
$9,500.40
|
| Rate for Payer: Cigna Commercial |
$13,458.90
|
| Rate for Payer: First Health Commercial |
$14,250.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,250.60
|
| Rate for Payer: GEHA Commercial |
$11,083.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,250.60
|
| Rate for Payer: Multiplan All |
$14,408.94
|
| Rate for Payer: OMNI Networks Commercial |
$11,083.80
|
| Rate for Payer: One Health Plan PPO/POS |
$14,250.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,042.30
|
| Rate for Payer: Three Rivers Provider Network All |
$11,875.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,725.62
|
| Rate for Payer: Zelis Auto |
$6,333.60
|
|
|
KIT CAP PERSONALIZED KNEE SYSTEM
|
Facility
|
OP
|
$15,834.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,958.50 |
| Max. Negotiated Rate |
$15,042.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,500.40
|
| Rate for Payer: Cash Price |
$9,500.40
|
| Rate for Payer: Cash Price |
$9,500.40
|
| Rate for Payer: Cigna Commercial |
$13,458.90
|
| Rate for Payer: First Health Commercial |
$14,250.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,250.60
|
| Rate for Payer: GEHA Commercial |
$12,667.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,250.60
|
| Rate for Payer: Humana ChoiceCare |
$4,116.84
|
| Rate for Payer: Multiplan All |
$14,408.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,500.40
|
| Rate for Payer: OMNI Networks Commercial |
$11,083.80
|
| Rate for Payer: One Health Plan PPO/POS |
$14,250.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,042.30
|
| Rate for Payer: Three Rivers Provider Network All |
$11,875.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13,933.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,958.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,725.62
|
| Rate for Payer: Zelis Auto |
$6,333.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,917.00
|
|
|
KIT DEVICE MILD VERTOS
|
Facility
|
OP
|
$10,350.00
|
|
|
Service Code
|
CPT C1889
|
| Hospital Charge Code |
7006690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.50 |
| Max. Negotiated Rate |
$9,832.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,210.00
|
| Rate for Payer: Cash Price |
$6,210.00
|
| Rate for Payer: Cash Price |
$6,210.00
|
| Rate for Payer: Cigna Commercial |
$8,797.50
|
| Rate for Payer: First Health Commercial |
$9,315.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,315.00
|
| Rate for Payer: GEHA Commercial |
$8,280.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,315.00
|
| Rate for Payer: Humana ChoiceCare |
$2,691.00
|
| Rate for Payer: Multiplan All |
$9,418.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,210.00
|
| Rate for Payer: OMNI Networks Commercial |
$7,245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9,315.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,832.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7,762.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,108.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,587.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,625.50
|
| Rate for Payer: Zelis Auto |
$4,140.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,175.00
|
|
