|
REMOVAL FOREIGN BODY INTRANASAL GEN ANES
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
6130310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$412.00
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
REMOVAL FOREIGN BODY INTRANASAL GEN ANES
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
21600492
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cigna Commercial |
$519.35
|
| Rate for Payer: First Health Commercial |
$549.90
|
| Rate for Payer: First Health Workers Compensation |
$235.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$549.90
|
| Rate for Payer: GEHA Commercial |
$427.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$549.90
|
| Rate for Payer: Multiplan All |
$556.01
|
| Rate for Payer: OMNI Networks Commercial |
$427.70
|
| Rate for Payer: One Health Plan PPO/POS |
$549.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$580.45
|
| Rate for Payer: Three Rivers Provider Network All |
$458.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$568.23
|
| Rate for Payer: Zelis Auto |
$244.40
|
| Rate for Payer: Zelis Worker's Compensation |
$166.80
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
7930300
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$327.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$464.10
|
| Rate for Payer: First Health Commercial |
$491.40
|
| Rate for Payer: First Health Workers Compensation |
$210.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$491.40
|
| Rate for Payer: GEHA Commercial |
$436.80
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$491.40
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$496.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$382.20
|
| Rate for Payer: One Health Plan PPO/POS |
$491.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$518.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$409.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$507.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$218.40
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$149.06
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
OP
|
$594.00
|
|
| Hospital Charge Code |
8130300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$504.90
|
| Rate for Payer: First Health Commercial |
$534.60
|
| Rate for Payer: First Health Workers Compensation |
$229.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$534.60
|
| Rate for Payer: GEHA Commercial |
$475.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$534.60
|
| Rate for Payer: Humana ChoiceCare |
$154.44
|
| Rate for Payer: Multiplan All |
$540.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$356.40
|
| Rate for Payer: OMNI Networks Commercial |
$415.80
|
| Rate for Payer: One Health Plan PPO/POS |
$534.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$564.30
|
| Rate for Payer: Three Rivers Provider Network All |
$445.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$522.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$552.42
|
| Rate for Payer: Zelis Auto |
$237.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$297.00
|
| Rate for Payer: Zelis Worker's Compensation |
$162.16
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
7930300
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$149.06 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$464.10
|
| Rate for Payer: First Health Commercial |
$491.40
|
| Rate for Payer: First Health Workers Compensation |
$210.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$491.40
|
| Rate for Payer: GEHA Commercial |
$382.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$491.40
|
| Rate for Payer: Multiplan All |
$496.86
|
| Rate for Payer: OMNI Networks Commercial |
$382.20
|
| Rate for Payer: One Health Plan PPO/POS |
$491.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$518.70
|
| Rate for Payer: Three Rivers Provider Network All |
$409.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$507.78
|
| Rate for Payer: Zelis Auto |
$218.40
|
| Rate for Payer: Zelis Worker's Compensation |
$149.06
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
21600162
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$199.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
8300041
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$149.06 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$464.10
|
| Rate for Payer: First Health Commercial |
$491.40
|
| Rate for Payer: First Health Workers Compensation |
$210.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$491.40
|
| Rate for Payer: GEHA Commercial |
$382.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$491.40
|
| Rate for Payer: Multiplan All |
$496.86
|
| Rate for Payer: OMNI Networks Commercial |
$382.20
|
| Rate for Payer: One Health Plan PPO/POS |
$491.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$518.70
|
| Rate for Payer: Three Rivers Provider Network All |
$409.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$507.78
|
| Rate for Payer: Zelis Auto |
$218.40
|
| Rate for Payer: Zelis Worker's Compensation |
$149.06
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
IP
|
$594.00
|
|
| Hospital Charge Code |
8130300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.16 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$504.90
|
| Rate for Payer: First Health Commercial |
$534.60
|
| Rate for Payer: First Health Workers Compensation |
$229.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$534.60
|
| Rate for Payer: GEHA Commercial |
$415.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$534.60
|
| Rate for Payer: Multiplan All |
$540.54
|
| Rate for Payer: OMNI Networks Commercial |
$415.80
|
| Rate for Payer: One Health Plan PPO/POS |
$534.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$564.30
|
| Rate for Payer: Three Rivers Provider Network All |
$445.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$552.42
|
| Rate for Payer: Zelis Auto |
$237.60
|
| Rate for Payer: Zelis Worker's Compensation |
$162.16
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
OP
|
$560.13
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
7230300
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$532.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$336.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$336.08
|
| Rate for Payer: Cash Price |
$336.08
|
| Rate for Payer: Cigna Commercial |
$476.11
|
| Rate for Payer: First Health Commercial |
$504.12
|
| Rate for Payer: First Health Workers Compensation |
$216.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$504.12
|
| Rate for Payer: GEHA Commercial |
$448.10
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$504.12
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$509.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$392.09
|
| Rate for Payer: One Health Plan PPO/POS |
$504.12
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$532.12
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$420.10
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$520.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$224.05
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$152.92
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
20300065
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.06 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$464.10
|
| Rate for Payer: First Health Commercial |
$491.40
|
| Rate for Payer: First Health Workers Compensation |
$210.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$491.40
|
| Rate for Payer: GEHA Commercial |
$382.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$491.40
|
| Rate for Payer: Multiplan All |
$496.86
|
| Rate for Payer: OMNI Networks Commercial |
$382.20
|
| Rate for Payer: One Health Plan PPO/POS |
$491.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$518.70
|
| Rate for Payer: Three Rivers Provider Network All |
$409.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$507.78
|
| Rate for Payer: Zelis Auto |
$218.40
|
| Rate for Payer: Zelis Worker's Compensation |
$149.06
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
6130300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$199.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
6130300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
20300065
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$327.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$464.10
|
| Rate for Payer: First Health Commercial |
$491.40
|
| Rate for Payer: First Health Workers Compensation |
$210.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$491.40
|
| Rate for Payer: GEHA Commercial |
$436.80
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$491.40
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$496.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$382.20
|
| Rate for Payer: One Health Plan PPO/POS |
$491.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$518.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$409.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$507.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$218.40
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$149.06
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
21600162
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
IP
|
$560.13
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
7230300
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$152.92 |
| Max. Negotiated Rate |
$532.12 |
| Rate for Payer: Cash Price |
$336.08
|
| Rate for Payer: Cigna Commercial |
$476.11
|
| Rate for Payer: First Health Commercial |
$504.12
|
| Rate for Payer: First Health Workers Compensation |
$216.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$504.12
|
| Rate for Payer: GEHA Commercial |
$392.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$504.12
|
| Rate for Payer: Multiplan All |
$509.72
|
| Rate for Payer: OMNI Networks Commercial |
$392.09
|
| Rate for Payer: One Health Plan PPO/POS |
$504.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$532.12
|
| Rate for Payer: Three Rivers Provider Network All |
$420.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$520.92
|
| Rate for Payer: Zelis Auto |
$224.05
|
| Rate for Payer: Zelis Worker's Compensation |
$152.92
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
OP
|
$560.13
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
8530300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$532.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$336.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$336.08
|
| Rate for Payer: Cash Price |
$336.08
|
| Rate for Payer: Cigna Commercial |
$476.11
|
| Rate for Payer: First Health Commercial |
$504.12
|
| Rate for Payer: First Health Workers Compensation |
$216.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$504.12
|
| Rate for Payer: GEHA Commercial |
$448.10
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$504.12
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$509.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$392.09
|
| Rate for Payer: One Health Plan PPO/POS |
$504.12
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$532.12
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$420.10
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$520.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$224.05
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$152.92
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
8300041
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$327.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$464.10
|
| Rate for Payer: First Health Commercial |
$491.40
|
| Rate for Payer: First Health Workers Compensation |
$210.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$491.40
|
| Rate for Payer: GEHA Commercial |
$436.80
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$491.40
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$496.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$382.20
|
| Rate for Payer: One Health Plan PPO/POS |
$491.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$518.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$409.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$507.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$218.40
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$149.06
|
|
|
REMOVAL FOREIGN BODY INTRANASAL OFFICE P
|
Facility
|
IP
|
$560.13
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
8530300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$152.92 |
| Max. Negotiated Rate |
$532.12 |
| Rate for Payer: Cash Price |
$336.08
|
| Rate for Payer: Cigna Commercial |
$476.11
|
| Rate for Payer: First Health Commercial |
$504.12
|
| Rate for Payer: First Health Workers Compensation |
$216.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$504.12
|
| Rate for Payer: GEHA Commercial |
$392.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$504.12
|
| Rate for Payer: Multiplan All |
$509.72
|
| Rate for Payer: OMNI Networks Commercial |
$392.09
|
| Rate for Payer: One Health Plan PPO/POS |
$504.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$532.12
|
| Rate for Payer: Three Rivers Provider Network All |
$420.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$520.92
|
| Rate for Payer: Zelis Auto |
$224.05
|
| Rate for Payer: Zelis Worker's Compensation |
$152.92
|
|
|
REMOVAL FOREIGN BODY MUS/TEN SHEATH SIMP
|
Facility
|
IP
|
$3,313.00
|
|
| Hospital Charge Code |
8120520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$904.45 |
| Max. Negotiated Rate |
$3,147.35 |
| Rate for Payer: Cash Price |
$1,987.80
|
| Rate for Payer: Cigna Commercial |
$2,816.05
|
| Rate for Payer: First Health Commercial |
$2,981.70
|
| Rate for Payer: First Health Workers Compensation |
$1,279.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,981.70
|
| Rate for Payer: GEHA Commercial |
$2,319.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,981.70
|
| Rate for Payer: Multiplan All |
$3,014.83
|
| Rate for Payer: OMNI Networks Commercial |
$2,319.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,981.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,147.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,484.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,081.09
|
| Rate for Payer: Zelis Auto |
$1,325.20
|
| Rate for Payer: Zelis Worker's Compensation |
$904.45
|
|
|
REMOVAL FOREIGN BODY MUS/TEN SHEATH SIMP
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
21600167
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$121.48 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$267.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$378.25
|
| Rate for Payer: First Health Commercial |
$400.50
|
| Rate for Payer: First Health Workers Compensation |
$171.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$400.50
|
| Rate for Payer: GEHA Commercial |
$356.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$400.50
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$404.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$311.50
|
| Rate for Payer: One Health Plan PPO/POS |
$400.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$422.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$333.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$413.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$178.00
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$121.48
|
|
|
REMOVAL FOREIGN BODY MUS/TEN SHEATH SIMP
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
21600167
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$121.48 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$378.25
|
| Rate for Payer: First Health Commercial |
$400.50
|
| Rate for Payer: First Health Workers Compensation |
$171.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$400.50
|
| Rate for Payer: GEHA Commercial |
$311.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$400.50
|
| Rate for Payer: Multiplan All |
$404.95
|
| Rate for Payer: OMNI Networks Commercial |
$311.50
|
| Rate for Payer: One Health Plan PPO/POS |
$400.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$422.75
|
| Rate for Payer: Three Rivers Provider Network All |
$333.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$413.85
|
| Rate for Payer: Zelis Auto |
$178.00
|
| Rate for Payer: Zelis Worker's Compensation |
$121.48
|
|
|
REMOVAL FOREIGN BODY MUS/TEN SHEATH SIMP
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
6120520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$121.48 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$267.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$349.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$378.25
|
| Rate for Payer: First Health Commercial |
$400.50
|
| Rate for Payer: First Health Workers Compensation |
$171.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$400.50
|
| Rate for Payer: GEHA Commercial |
$356.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$400.50
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$356.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$404.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$311.50
|
| Rate for Payer: One Health Plan PPO/POS |
$400.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$411.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$356.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$422.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$333.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$413.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$178.00
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$121.48
|
|
|
REMOVAL FOREIGN BODY MUS/TEN SHEATH SIMP
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
6120520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$121.48 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$378.25
|
| Rate for Payer: First Health Commercial |
$400.50
|
| Rate for Payer: First Health Workers Compensation |
$171.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$400.50
|
| Rate for Payer: GEHA Commercial |
$311.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$400.50
|
| Rate for Payer: Multiplan All |
$404.95
|
| Rate for Payer: OMNI Networks Commercial |
$311.50
|
| Rate for Payer: One Health Plan PPO/POS |
$400.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$422.75
|
| Rate for Payer: Three Rivers Provider Network All |
$333.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$413.85
|
| Rate for Payer: Zelis Auto |
$178.00
|
| Rate for Payer: Zelis Worker's Compensation |
$121.48
|
|
|
REMOVAL FOREIGN BODY MUS/TEN SHEATH SIMP
|
Facility
|
OP
|
$3,313.00
|
|
| Hospital Charge Code |
8120520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$828.25 |
| Max. Negotiated Rate |
$3,147.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,987.80
|
| Rate for Payer: Cash Price |
$1,987.80
|
| Rate for Payer: Cigna Commercial |
$2,816.05
|
| Rate for Payer: First Health Commercial |
$2,981.70
|
| Rate for Payer: First Health Workers Compensation |
$1,279.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,981.70
|
| Rate for Payer: GEHA Commercial |
$2,650.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,981.70
|
| Rate for Payer: Humana ChoiceCare |
$861.38
|
| Rate for Payer: Multiplan All |
$3,014.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,987.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,319.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,981.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,147.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,484.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,915.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$828.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,081.09
|
| Rate for Payer: Zelis Auto |
$1,325.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,656.50
|
| Rate for Payer: Zelis Worker's Compensation |
$904.45
|
|
|
REMOVAL FOREIGN BODY PELVIS/HIP DEEP
|
Facility
|
OP
|
$1,925.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
21600484
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$525.52 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cigna Commercial |
$1,636.25
|
| Rate for Payer: First Health Commercial |
$1,732.50
|
| Rate for Payer: First Health Workers Compensation |
$743.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,732.50
|
| Rate for Payer: GEHA Commercial |
$1,540.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,732.50
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,751.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,347.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,732.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,828.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,443.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,790.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$770.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$525.52
|
|
