|
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
|
IP
|
$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: 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 |
20300083
|
|
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
|
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 INSTRUM UNILAT
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
7969210
|
|
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
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUM UNILAT
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
7969210
|
|
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 IRRIG/LVG UNILA
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
7969209
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$32.80
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| 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 |
$67.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
9369209
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$32.80
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| 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 |
$67.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
21069209
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$289.00
|
| Rate for Payer: First Health Commercial |
$306.00
|
| Rate for Payer: First Health Workers Compensation |
$131.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.00
|
| Rate for Payer: GEHA Commercial |
$272.00
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.00
|
| 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 |
$67.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$309.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$238.00
|
| Rate for Payer: One Health Plan PPO/POS |
$306.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$255.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$316.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$136.00
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$92.82
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
2160003
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$32.80
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| 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 |
$67.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
21069209
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$289.00
|
| Rate for Payer: First Health Commercial |
$306.00
|
| Rate for Payer: First Health Workers Compensation |
$131.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.00
|
| Rate for Payer: GEHA Commercial |
$238.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.00
|
| Rate for Payer: Multiplan All |
$309.40
|
| Rate for Payer: OMNI Networks Commercial |
$238.00
|
| Rate for Payer: One Health Plan PPO/POS |
$306.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.00
|
| Rate for Payer: Three Rivers Provider Network All |
$255.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$316.20
|
| Rate for Payer: Zelis Auto |
$136.00
|
| Rate for Payer: Zelis Worker's Compensation |
$92.82
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
2160003
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$28.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
8169209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$253.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
IP
|
$41.67
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
7269209
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$39.59 |
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$35.42
|
| Rate for Payer: First Health Commercial |
$37.50
|
| Rate for Payer: First Health Workers Compensation |
$16.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$37.50
|
| Rate for Payer: GEHA Commercial |
$29.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$37.50
|
| Rate for Payer: Multiplan All |
$37.92
|
| Rate for Payer: OMNI Networks Commercial |
$29.17
|
| Rate for Payer: One Health Plan PPO/POS |
$37.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$39.59
|
| Rate for Payer: Three Rivers Provider Network All |
$31.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.75
|
| Rate for Payer: Zelis Auto |
$16.67
|
| Rate for Payer: Zelis Worker's Compensation |
$11.38
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
OP
|
$41.67
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
7269209
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$25.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$35.42
|
| Rate for Payer: First Health Commercial |
$37.50
|
| Rate for Payer: First Health Workers Compensation |
$16.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$37.50
|
| Rate for Payer: GEHA Commercial |
$33.34
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$37.50
|
| 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 |
$67.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$37.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$29.17
|
| Rate for Payer: One Health Plan PPO/POS |
$37.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$39.59
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$31.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$16.67
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$11.38
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
IP
|
$41.67
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
8500003
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$39.59 |
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$35.42
|
| Rate for Payer: First Health Commercial |
$37.50
|
| Rate for Payer: First Health Workers Compensation |
$16.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$37.50
|
| Rate for Payer: GEHA Commercial |
$29.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$37.50
|
| Rate for Payer: Multiplan All |
$37.92
|
| Rate for Payer: OMNI Networks Commercial |
$29.17
|
| Rate for Payer: One Health Plan PPO/POS |
$37.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$39.59
|
| Rate for Payer: Three Rivers Provider Network All |
$31.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.75
|
| Rate for Payer: Zelis Auto |
$16.67
|
| Rate for Payer: Zelis Worker's Compensation |
$11.38
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
7969209
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$28.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
8169209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$289.60
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| 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 |
$67.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
21600228
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$28.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
21600228
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$32.80
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| 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 |
$67.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
9369209
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$28.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
REMOVAL IMPACTED CERUMEN IRRIG/LVG UNILA
|
Facility
|
OP
|
$41.67
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
8500003
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$25.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$35.42
|
| Rate for Payer: First Health Commercial |
$37.50
|
| Rate for Payer: First Health Workers Compensation |
$16.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$37.50
|
| Rate for Payer: GEHA Commercial |
$33.34
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$37.50
|
| 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 |
$67.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$37.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$29.17
|
| Rate for Payer: One Health Plan PPO/POS |
$37.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$39.59
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$31.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$16.67
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$11.38
|
|
|
REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSUL
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
6111976
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$79.44 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$247.35
|
| Rate for Payer: First Health Commercial |
$261.90
|
| Rate for Payer: First Health Workers Compensation |
$112.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.90
|
| Rate for Payer: GEHA Commercial |
$203.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.90
|
| Rate for Payer: Multiplan All |
$264.81
|
| Rate for Payer: OMNI Networks Commercial |
$203.70
|
| Rate for Payer: One Health Plan PPO/POS |
$261.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$276.45
|
| Rate for Payer: Three Rivers Provider Network All |
$218.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$270.63
|
| Rate for Payer: Zelis Auto |
$116.40
|
| Rate for Payer: Zelis Worker's Compensation |
$79.44
|
|
|
REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSUL
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
6111976
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$79.44 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$567.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$174.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$567.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$449.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$247.35
|
| Rate for Payer: First Health Commercial |
$261.90
|
| Rate for Payer: First Health Workers Compensation |
$112.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.90
|
| Rate for Payer: GEHA Commercial |
$232.80
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.90
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$458.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$264.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$203.70
|
| Rate for Payer: One Health Plan PPO/POS |
$261.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$529.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$458.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$276.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$218.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$458.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$270.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$116.40
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$79.44
|
|
|
REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSUL
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
23511976
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$120.39 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna Commercial |
$374.85
|
| Rate for Payer: First Health Commercial |
$396.90
|
| Rate for Payer: First Health Workers Compensation |
$170.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$396.90
|
| Rate for Payer: GEHA Commercial |
$308.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$396.90
|
| Rate for Payer: Multiplan All |
$401.31
|
| Rate for Payer: OMNI Networks Commercial |
$308.70
|
| Rate for Payer: One Health Plan PPO/POS |
$396.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$418.95
|
| Rate for Payer: Three Rivers Provider Network All |
$330.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$410.13
|
| Rate for Payer: Zelis Auto |
$176.40
|
| Rate for Payer: Zelis Worker's Compensation |
$120.39
|
|
