|
RMVL FB XTRNL AUDITORY CANAL ANES
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
21600472
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$255.85
|
| Rate for Payer: First Health Commercial |
$270.90
|
| Rate for Payer: First Health Workers Compensation |
$116.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.90
|
| Rate for Payer: GEHA Commercial |
$210.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.90
|
| Rate for Payer: Multiplan All |
$273.91
|
| Rate for Payer: OMNI Networks Commercial |
$210.70
|
| Rate for Payer: One Health Plan PPO/POS |
$270.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.95
|
| Rate for Payer: Three Rivers Provider Network All |
$225.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.93
|
| Rate for Payer: Zelis Auto |
$120.40
|
| Rate for Payer: Zelis Worker's Compensation |
$82.17
|
|
|
RMVL FB XTRNL AUDITORY CANAL ANES
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
6169205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$217.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
RMVL FB XTRNL AUDITORY CANAL ANES
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
21600472
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$255.85
|
| Rate for Payer: First Health Commercial |
$270.90
|
| Rate for Payer: First Health Workers Compensation |
$116.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.90
|
| Rate for Payer: GEHA Commercial |
$240.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.90
|
| 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 |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$273.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$210.70
|
| Rate for Payer: One Health Plan PPO/POS |
$270.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$225.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$120.40
|
| 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 |
$82.17
|
|
|
RMVL FB XTRNL AUDITORY CANAL ANES
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
6169205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$248.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| 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 |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
IP
|
$223.17
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
8569200
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$60.93 |
| Max. Negotiated Rate |
$212.01 |
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Cigna Commercial |
$189.69
|
| Rate for Payer: First Health Commercial |
$200.85
|
| Rate for Payer: First Health Workers Compensation |
$86.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.85
|
| Rate for Payer: GEHA Commercial |
$156.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.85
|
| Rate for Payer: Multiplan All |
$203.08
|
| Rate for Payer: OMNI Networks Commercial |
$156.22
|
| Rate for Payer: One Health Plan PPO/POS |
$200.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$212.01
|
| Rate for Payer: Three Rivers Provider Network All |
$167.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.55
|
| Rate for Payer: Zelis Auto |
$89.27
|
| Rate for Payer: Zelis Worker's Compensation |
$60.93
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
OP
|
$223.17
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
7269200
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$60.93 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Cigna Commercial |
$189.69
|
| Rate for Payer: First Health Commercial |
$200.85
|
| Rate for Payer: First Health Workers Compensation |
$86.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.85
|
| Rate for Payer: GEHA Commercial |
$178.54
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.85
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$203.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$156.22
|
| Rate for Payer: One Health Plan PPO/POS |
$200.85
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$212.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$167.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$89.27
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$60.93
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
OP
|
$223.17
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
8569200
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$60.93 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Cigna Commercial |
$189.69
|
| Rate for Payer: First Health Commercial |
$200.85
|
| Rate for Payer: First Health Workers Compensation |
$86.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.85
|
| Rate for Payer: GEHA Commercial |
$178.54
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.85
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$203.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$156.22
|
| Rate for Payer: One Health Plan PPO/POS |
$200.85
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$212.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$167.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$89.27
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$60.93
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
21600161
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: First Health Workers Compensation |
$56.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$102.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Worker's Compensation |
$40.13
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
21600161
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: First Health Workers Compensation |
$56.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$40.13
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
6169200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: First Health Workers Compensation |
$56.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$40.13
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
8300054
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: First Health Workers Compensation |
$94.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$171.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.89
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
7969200
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: First Health Workers Compensation |
$94.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$66.89
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
OP
|
$296.00
|
|
| Hospital Charge Code |
8150050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: First Health Workers Compensation |
$114.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$236.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Humana ChoiceCare |
$76.96
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$177.60
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$260.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: Zelis Auto |
$118.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$148.00
|
| Rate for Payer: Zelis Worker's Compensation |
$80.81
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
7969200
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: First Health Workers Compensation |
$94.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$171.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.89
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
20300082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: First Health Workers Compensation |
$94.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$171.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.89
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
8300054
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: First Health Workers Compensation |
$94.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$66.89
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
20300082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: First Health Workers Compensation |
$94.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$66.89
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
IP
|
$296.00
|
|
| Hospital Charge Code |
8150050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: First Health Workers Compensation |
$114.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: Zelis Auto |
$118.40
|
| Rate for Payer: Zelis Worker's Compensation |
$80.81
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
IP
|
$223.17
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
7269200
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$60.93 |
| Max. Negotiated Rate |
$212.01 |
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Cigna Commercial |
$189.69
|
| Rate for Payer: First Health Commercial |
$200.85
|
| Rate for Payer: First Health Workers Compensation |
$86.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.85
|
| Rate for Payer: GEHA Commercial |
$156.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.85
|
| Rate for Payer: Multiplan All |
$203.08
|
| Rate for Payer: OMNI Networks Commercial |
$156.22
|
| Rate for Payer: One Health Plan PPO/POS |
$200.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$212.01
|
| Rate for Payer: Three Rivers Provider Network All |
$167.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.55
|
| Rate for Payer: Zelis Auto |
$89.27
|
| Rate for Payer: Zelis Worker's Compensation |
$60.93
|
|
|
RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
6169200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: First Health Workers Compensation |
$56.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$102.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Worker's Compensation |
$40.13
|
|
|
RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
21600159
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$122.55 |
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$109.65
|
| Rate for Payer: First Health Commercial |
$116.10
|
| Rate for Payer: First Health Workers Compensation |
$49.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$116.10
|
| Rate for Payer: GEHA Commercial |
$90.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$116.10
|
| Rate for Payer: Multiplan All |
$117.39
|
| Rate for Payer: OMNI Networks Commercial |
$90.30
|
| Rate for Payer: One Health Plan PPO/POS |
$116.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$122.55
|
| Rate for Payer: Three Rivers Provider Network All |
$96.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.97
|
| Rate for Payer: Zelis Auto |
$51.60
|
| Rate for Payer: Zelis Worker's Compensation |
$35.22
|
|
|
RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
21600159
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$109.65
|
| Rate for Payer: First Health Commercial |
$116.10
|
| Rate for Payer: First Health Workers Compensation |
$49.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$116.10
|
| Rate for Payer: GEHA Commercial |
$103.20
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$116.10
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$122.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$117.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$90.30
|
| Rate for Payer: One Health Plan PPO/POS |
$116.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$141.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$122.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$96.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$51.60
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$35.22
|
|
|
RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
21600160
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$122.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$141.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
21600160
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL N
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
21600227
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$61.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$128.00
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$122.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$141.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$43.68
|
|
