|
REMOVAL FOREIGN BODY PELVIS/HIP DEEP
|
Facility
|
IP
|
$1,925.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
21600484
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$525.52 |
| Max. Negotiated Rate |
$1,828.75 |
| 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 |
$1,347.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,732.50
|
| Rate for Payer: Multiplan All |
$1,751.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,347.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,732.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,828.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,443.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,790.25
|
| Rate for Payer: Zelis Auto |
$770.00
|
| Rate for Payer: Zelis Worker's Compensation |
$525.52
|
|
|
REMOVAL FOREIGN BODY PELVIS/HIP DEEP
|
Facility
|
OP
|
$1,285.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
6127087
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$350.81 |
| 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 |
$771.00
|
| 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 |
$771.00
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,092.25
|
| Rate for Payer: First Health Commercial |
$1,156.50
|
| Rate for Payer: First Health Workers Compensation |
$496.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,156.50
|
| Rate for Payer: GEHA Commercial |
$1,028.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,156.50
|
| 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 |
$1,169.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$899.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,156.50
|
| 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 |
$1,220.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$963.75
|
| 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 |
$1,195.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$514.00
|
| 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 |
$350.81
|
|
|
REMOVAL FOREIGN BODY PELVIS/HIP DEEP
|
Facility
|
IP
|
$1,285.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
6127087
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$350.81 |
| Max. Negotiated Rate |
$1,220.75 |
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,092.25
|
| Rate for Payer: First Health Commercial |
$1,156.50
|
| Rate for Payer: First Health Workers Compensation |
$496.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,156.50
|
| Rate for Payer: GEHA Commercial |
$899.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,156.50
|
| Rate for Payer: Multiplan All |
$1,169.35
|
| Rate for Payer: OMNI Networks Commercial |
$899.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,156.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,220.75
|
| Rate for Payer: Three Rivers Provider Network All |
$963.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,195.05
|
| Rate for Payer: Zelis Auto |
$514.00
|
| Rate for Payer: Zelis Worker's Compensation |
$350.81
|
|
|
REMOVAL FOREIGN BODY SCROTUM
|
Facility
|
IP
|
$1,106.00
|
|
|
Service Code
|
CPT 55120
|
| Hospital Charge Code |
21600496
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$301.94 |
| Max. Negotiated Rate |
$1,050.70 |
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cigna Commercial |
$940.10
|
| Rate for Payer: First Health Commercial |
$995.40
|
| Rate for Payer: First Health Workers Compensation |
$427.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$995.40
|
| Rate for Payer: GEHA Commercial |
$774.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$995.40
|
| Rate for Payer: Multiplan All |
$1,006.46
|
| Rate for Payer: OMNI Networks Commercial |
$774.20
|
| Rate for Payer: One Health Plan PPO/POS |
$995.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,050.70
|
| Rate for Payer: Three Rivers Provider Network All |
$829.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,028.58
|
| Rate for Payer: Zelis Auto |
$442.40
|
| Rate for Payer: Zelis Worker's Compensation |
$301.94
|
|
|
REMOVAL FOREIGN BODY SCROTUM
|
Facility
|
OP
|
$914.00
|
|
|
Service Code
|
CPT 55120
|
| Hospital Charge Code |
6155120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$249.52 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cigna Commercial |
$776.90
|
| Rate for Payer: First Health Commercial |
$822.60
|
| Rate for Payer: First Health Workers Compensation |
$352.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.60
|
| Rate for Payer: GEHA Commercial |
$731.20
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.60
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$831.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$639.80
|
| Rate for Payer: One Health Plan PPO/POS |
$822.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$868.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$685.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$365.60
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$249.52
|
|
|
REMOVAL FOREIGN BODY SCROTUM
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
CPT 55120
|
| Hospital Charge Code |
21600496
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$301.94 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$663.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cigna Commercial |
$940.10
|
| Rate for Payer: First Health Commercial |
$995.40
|
| Rate for Payer: First Health Workers Compensation |
$427.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$995.40
|
| Rate for Payer: GEHA Commercial |
$884.80
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$995.40
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$1,006.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$774.20
|
| Rate for Payer: One Health Plan PPO/POS |
$995.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,050.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$829.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,028.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$442.40
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$301.94
|
|
|
REMOVAL FOREIGN BODY SCROTUM
|
Facility
|
IP
|
$914.00
|
|
|
Service Code
|
CPT 55120
|
| Hospital Charge Code |
6155120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$249.52 |
| Max. Negotiated Rate |
$868.30 |
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cigna Commercial |
$776.90
|
| Rate for Payer: First Health Commercial |
$822.60
|
| Rate for Payer: First Health Workers Compensation |
$352.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.60
|
| Rate for Payer: GEHA Commercial |
$639.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.60
|
| Rate for Payer: Multiplan All |
$831.74
|
| Rate for Payer: OMNI Networks Commercial |
$639.80
|
| Rate for Payer: One Health Plan PPO/POS |
$822.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$868.30
|
| Rate for Payer: Three Rivers Provider Network All |
$685.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.02
|
| Rate for Payer: Zelis Auto |
$365.60
|
| Rate for Payer: Zelis Worker's Compensation |
$249.52
|
|
|
REMOVAL FOREIGN BODY SHOULDER SUBCUTANEO
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 23330
|
| Hospital Charge Code |
6123330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.31 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$390.15
|
| Rate for Payer: First Health Commercial |
$413.10
|
| Rate for Payer: First Health Workers Compensation |
$177.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$413.10
|
| Rate for Payer: GEHA Commercial |
$321.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$413.10
|
| Rate for Payer: Multiplan All |
$417.69
|
| Rate for Payer: OMNI Networks Commercial |
$321.30
|
| Rate for Payer: One Health Plan PPO/POS |
$413.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$436.05
|
| Rate for Payer: Three Rivers Provider Network All |
$344.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$426.87
|
| Rate for Payer: Zelis Auto |
$183.60
|
| Rate for Payer: Zelis Worker's Compensation |
$125.31
|
|
|
REMOVAL FOREIGN BODY SHOULDER SUBCUTANEO
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 23330
|
| Hospital Charge Code |
6123330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.31 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$390.15
|
| Rate for Payer: First Health Commercial |
$413.10
|
| Rate for Payer: First Health Workers Compensation |
$177.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$413.10
|
| Rate for Payer: GEHA Commercial |
$367.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$413.10
|
| 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 |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$417.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$321.30
|
| Rate for Payer: One Health Plan PPO/POS |
$413.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$436.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$344.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$426.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$183.60
|
| 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 |
$125.31
|
|
|
REMOVAL FOREIGN BODY SHOULDER SUBCUTANEO
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT 23330
|
| Hospital Charge Code |
21600500
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$229.87 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: First Health Workers Compensation |
$325.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$673.60
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| 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 |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$336.80
|
| 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 |
$229.87
|
|
|
REMOVAL FOREIGN BODY SHOULDER SUBCUTANEO
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT 23330
|
| Hospital Charge Code |
21600500
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$229.87 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: First Health Workers Compensation |
$325.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$589.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: Zelis Auto |
$336.80
|
| Rate for Payer: Zelis Worker's Compensation |
$229.87
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
1969210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$228.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$147.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$304.80
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
1969210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$147.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$266.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
8150051
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$100.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
20300083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
OP
|
$134.13
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
7269210
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$127.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$80.48
|
| Rate for Payer: Cash Price |
$80.48
|
| Rate for Payer: Cigna Commercial |
$114.01
|
| Rate for Payer: First Health Commercial |
$120.72
|
| Rate for Payer: First Health Workers Compensation |
$51.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.72
|
| Rate for Payer: GEHA Commercial |
$107.30
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.72
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$122.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$93.89
|
| Rate for Payer: One Health Plan PPO/POS |
$120.72
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.42
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$100.60
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$53.65
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$36.62
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
8150051
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
25500035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
25500035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$100.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
21600035
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
8369210
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
8569210
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
9369210
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
8569210
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$100.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENT UNIL
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
8369210
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$100.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
