|
NASAL APPLICATION DEVICE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT A7034
|
| Hospital Charge Code |
3000014
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$132.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Humana ChoiceCare |
$43.16
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$99.60
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$83.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
NASAL APPLICATION DEVICE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT A7034
|
| Hospital Charge Code |
3000014
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: First Health Workers Compensation |
$64.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$116.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Worker's Compensation |
$45.32
|
|
|
NASAL ENDOSCOPY DX
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
6131231
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.15 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$171.70
|
| Rate for Payer: First Health Commercial |
$181.80
|
| Rate for Payer: First Health Workers Compensation |
$77.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$181.80
|
| Rate for Payer: GEHA Commercial |
$141.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$181.80
|
| Rate for Payer: Multiplan All |
$183.82
|
| Rate for Payer: OMNI Networks Commercial |
$141.40
|
| Rate for Payer: One Health Plan PPO/POS |
$181.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$191.90
|
| Rate for Payer: Three Rivers Provider Network All |
$151.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$187.86
|
| Rate for Payer: Zelis Auto |
$80.80
|
| Rate for Payer: Zelis Worker's Compensation |
$55.15
|
|
|
NASAL ENDOSCOPY DX
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
6131231
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.15 |
| Max. Negotiated Rate |
$368.68 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$147.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$184.34
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$171.70
|
| Rate for Payer: First Health Commercial |
$181.80
|
| Rate for Payer: First Health Workers Compensation |
$77.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$181.80
|
| Rate for Payer: GEHA Commercial |
$161.60
|
| Rate for Payer: GEHA Medicare |
$184.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$181.80
|
| Rate for Payer: Humana ChoiceCare |
$202.77
|
| Rate for Payer: Humana Medicare Advantage |
$184.34
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$309.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$150.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$184.34
|
| Rate for Payer: Multiplan All |
$183.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$313.38
|
| Rate for Payer: OMNI Networks Commercial |
$141.40
|
| Rate for Payer: One Health Plan PPO/POS |
$181.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$173.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$150.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$184.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$191.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$368.68
|
| Rate for Payer: Three Rivers Provider Network All |
$151.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$180.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$187.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$184.34
|
| Rate for Payer: Zelis Auto |
$80.80
|
| Rate for Payer: Zelis Medicare |
$156.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$221.21
|
| Rate for Payer: Zelis Worker's Compensation |
$55.15
|
|
|
NASAL PAD FOR BIPAP
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99070
|
| Hospital Charge Code |
4000708
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$63.75
|
| Rate for Payer: First Health Commercial |
$67.50
|
| Rate for Payer: First Health Workers Compensation |
$28.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$67.50
|
| Rate for Payer: GEHA Commercial |
$60.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$67.50
|
| Rate for Payer: Humana ChoiceCare |
$19.50
|
| Rate for Payer: Multiplan All |
$68.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$45.00
|
| Rate for Payer: OMNI Networks Commercial |
$52.50
|
| Rate for Payer: One Health Plan PPO/POS |
$67.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$71.25
|
| Rate for Payer: Three Rivers Provider Network All |
$56.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$69.75
|
| Rate for Payer: Zelis Auto |
$30.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$37.50
|
| Rate for Payer: Zelis Worker's Compensation |
$20.48
|
|
|
NASAL PAD FOR BIPAP
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99070
|
| Hospital Charge Code |
4000708
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$63.75
|
| Rate for Payer: First Health Commercial |
$67.50
|
| Rate for Payer: First Health Workers Compensation |
$28.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$67.50
|
| Rate for Payer: GEHA Commercial |
$52.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$67.50
|
| Rate for Payer: Multiplan All |
$68.25
|
| Rate for Payer: OMNI Networks Commercial |
$52.50
|
| Rate for Payer: One Health Plan PPO/POS |
$67.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$71.25
|
| Rate for Payer: Three Rivers Provider Network All |
$56.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$69.75
|
| Rate for Payer: Zelis Auto |
$30.00
|
| Rate for Payer: Zelis Worker's Compensation |
$20.48
|
|
|
NASAL/SINUS ENDOSCOPY DX
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
CPT 31235
|
| Hospital Charge Code |
6131235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$136.77 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna Commercial |
$425.85
|
| Rate for Payer: First Health Commercial |
$450.90
|
| Rate for Payer: First Health Workers Compensation |
$193.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.90
|
| Rate for Payer: GEHA Commercial |
$350.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.90
|
| Rate for Payer: Multiplan All |
$455.91
|
| Rate for Payer: OMNI Networks Commercial |
$350.70
|
| Rate for Payer: One Health Plan PPO/POS |
$450.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.95
|
| Rate for Payer: Three Rivers Provider Network All |
$375.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.93
|
| Rate for Payer: Zelis Auto |
$200.40
|
| Rate for Payer: Zelis Worker's Compensation |
$136.77
|
|
|
NASAL/SINUS ENDOSCOPY DX
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
CPT 31235
|
| Hospital Charge Code |
6131235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$136.77 |
| Max. Negotiated Rate |
$3,274.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,734.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,637.45
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna Commercial |
$425.85
|
| Rate for Payer: First Health Commercial |
$450.90
|
| Rate for Payer: First Health Workers Compensation |
$193.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.90
|
| Rate for Payer: GEHA Commercial |
$400.80
|
| Rate for Payer: GEHA Medicare |
$1,637.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.90
|
| Rate for Payer: Humana ChoiceCare |
$1,801.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,637.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,750.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,770.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,637.45
|
| Rate for Payer: Multiplan All |
$455.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,783.66
|
| Rate for Payer: OMNI Networks Commercial |
$350.70
|
| Rate for Payer: One Health Plan PPO/POS |
$450.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,043.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,770.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,637.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$375.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,604.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,770.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,637.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,637.45
|
| Rate for Payer: Zelis Auto |
$200.40
|
| Rate for Payer: Zelis Medicare |
$1,391.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,964.94
|
| Rate for Payer: Zelis Worker's Compensation |
$136.77
|
|
|
NASAL/SINUS ENDOSCOPY DX
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
CPT 31233
|
| Hospital Charge Code |
6131233
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$115.21 |
| Max. Negotiated Rate |
$737.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$253.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$147.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$368.72
|
| Rate for Payer: Cash Price |
$253.20
|
| Rate for Payer: Cash Price |
$253.20
|
| Rate for Payer: Cigna Commercial |
$358.70
|
| Rate for Payer: First Health Commercial |
$379.80
|
| Rate for Payer: First Health Workers Compensation |
$162.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$379.80
|
| Rate for Payer: GEHA Commercial |
$337.60
|
| Rate for Payer: GEHA Medicare |
$368.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$379.80
|
| Rate for Payer: Humana ChoiceCare |
$405.59
|
| Rate for Payer: Humana Medicare Advantage |
$368.72
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$619.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$150.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$368.72
|
| Rate for Payer: Multiplan All |
$384.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$626.82
|
| Rate for Payer: OMNI Networks Commercial |
$295.40
|
| Rate for Payer: One Health Plan PPO/POS |
$379.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$173.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$150.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$368.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$400.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$737.44
|
| Rate for Payer: Three Rivers Provider Network All |
$316.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$361.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$368.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$392.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$368.72
|
| Rate for Payer: Zelis Auto |
$168.80
|
| Rate for Payer: Zelis Medicare |
$313.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$442.46
|
| Rate for Payer: Zelis Worker's Compensation |
$115.21
|
|
|
NASAL/SINUS ENDOSCOPY DX
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
CPT 31233
|
| Hospital Charge Code |
6131233
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$115.21 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Cash Price |
$253.20
|
| Rate for Payer: Cigna Commercial |
$358.70
|
| Rate for Payer: First Health Commercial |
$379.80
|
| Rate for Payer: First Health Workers Compensation |
$162.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$379.80
|
| Rate for Payer: GEHA Commercial |
$295.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$379.80
|
| Rate for Payer: Multiplan All |
$384.02
|
| Rate for Payer: OMNI Networks Commercial |
$295.40
|
| Rate for Payer: One Health Plan PPO/POS |
$379.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$400.90
|
| Rate for Payer: Three Rivers Provider Network All |
$316.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$392.46
|
| Rate for Payer: Zelis Auto |
$168.80
|
| Rate for Payer: Zelis Worker's Compensation |
$115.21
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT 31287
|
| Hospital Charge Code |
6131287
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$164.07 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$360.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$360.60
|
| Rate for Payer: Cash Price |
$360.60
|
| Rate for Payer: Cigna Commercial |
$510.85
|
| Rate for Payer: First Health Commercial |
$540.90
|
| Rate for Payer: First Health Workers Compensation |
$232.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$540.90
|
| Rate for Payer: GEHA Commercial |
$480.80
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$540.90
|
| Rate for Payer: Humana ChoiceCare |
$7,230.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,573.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,042.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,392.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$546.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$420.70
|
| Rate for Payer: One Health Plan PPO/POS |
$540.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,762.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,392.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$570.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$450.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,392.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$558.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$240.40
|
| Rate for Payer: Zelis Medicare |
$5,587.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,887.79
|
| Rate for Payer: Zelis Worker's Compensation |
$164.07
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
6131237
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: First Health Commercial |
$450.00
|
| Rate for Payer: First Health Workers Compensation |
$193.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.00
|
| Rate for Payer: GEHA Commercial |
$350.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.00
|
| Rate for Payer: Multiplan All |
$455.00
|
| Rate for Payer: OMNI Networks Commercial |
$350.00
|
| Rate for Payer: One Health Plan PPO/POS |
$450.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.00
|
| Rate for Payer: Three Rivers Provider Network All |
$375.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.00
|
| Rate for Payer: Zelis Auto |
$200.00
|
| Rate for Payer: Zelis Worker's Compensation |
$136.50
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
6131237
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$3,274.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,734.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,637.45
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: First Health Commercial |
$450.00
|
| Rate for Payer: First Health Workers Compensation |
$193.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.00
|
| Rate for Payer: GEHA Commercial |
$400.00
|
| Rate for Payer: GEHA Medicare |
$1,637.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.00
|
| Rate for Payer: Humana ChoiceCare |
$1,801.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,637.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,750.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,770.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,637.45
|
| Rate for Payer: Multiplan All |
$455.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,783.66
|
| Rate for Payer: OMNI Networks Commercial |
$350.00
|
| Rate for Payer: One Health Plan PPO/POS |
$450.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,043.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,770.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,637.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$375.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,604.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,770.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,637.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,637.45
|
| Rate for Payer: Zelis Auto |
$200.00
|
| Rate for Payer: Zelis Medicare |
$1,391.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,964.94
|
| Rate for Payer: Zelis Worker's Compensation |
$136.50
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
6131238
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.05 |
| Max. Negotiated Rate |
$3,274.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$314.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,734.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,637.45
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$445.40
|
| Rate for Payer: First Health Commercial |
$471.60
|
| Rate for Payer: First Health Workers Compensation |
$202.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$471.60
|
| Rate for Payer: GEHA Commercial |
$419.20
|
| Rate for Payer: GEHA Medicare |
$1,637.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$471.60
|
| Rate for Payer: Humana ChoiceCare |
$1,801.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,637.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,750.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,770.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,637.45
|
| Rate for Payer: Multiplan All |
$476.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,783.66
|
| Rate for Payer: OMNI Networks Commercial |
$366.80
|
| Rate for Payer: One Health Plan PPO/POS |
$471.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,043.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,770.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,637.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$497.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$393.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,604.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,770.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,637.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$487.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,637.45
|
| Rate for Payer: Zelis Auto |
$209.60
|
| Rate for Payer: Zelis Medicare |
$1,391.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,964.94
|
| Rate for Payer: Zelis Worker's Compensation |
$143.05
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
OP
|
$1,247.00
|
|
|
Service Code
|
CPT 31239
|
| Hospital Charge Code |
6131239
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.43 |
| Max. Negotiated Rate |
$7,001.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$748.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,500.91
|
| Rate for Payer: Cash Price |
$748.20
|
| Rate for Payer: Cash Price |
$748.20
|
| Rate for Payer: Cigna Commercial |
$1,059.95
|
| Rate for Payer: First Health Commercial |
$1,122.30
|
| Rate for Payer: First Health Workers Compensation |
$481.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,122.30
|
| Rate for Payer: GEHA Commercial |
$997.60
|
| Rate for Payer: GEHA Medicare |
$3,500.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,122.30
|
| Rate for Payer: Humana ChoiceCare |
$3,851.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,500.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,881.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,392.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,500.91
|
| Rate for Payer: Multiplan All |
$1,134.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,951.55
|
| Rate for Payer: OMNI Networks Commercial |
$872.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,122.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,762.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,392.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,500.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,184.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,001.82
|
| Rate for Payer: Three Rivers Provider Network All |
$935.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,430.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,392.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,500.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,159.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,500.91
|
| Rate for Payer: Zelis Auto |
$498.80
|
| Rate for Payer: Zelis Medicare |
$2,975.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,201.09
|
| Rate for Payer: Zelis Worker's Compensation |
$340.43
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
IP
|
$2,552.00
|
|
|
Service Code
|
CPT 31291
|
| Hospital Charge Code |
6131291
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$696.70 |
| Max. Negotiated Rate |
$2,424.40 |
| Rate for Payer: Cash Price |
$1,531.20
|
| Rate for Payer: Cigna Commercial |
$2,169.20
|
| Rate for Payer: First Health Commercial |
$2,296.80
|
| Rate for Payer: First Health Workers Compensation |
$985.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,296.80
|
| Rate for Payer: GEHA Commercial |
$1,786.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,296.80
|
| Rate for Payer: Multiplan All |
$2,322.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,786.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,296.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,424.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,914.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,373.36
|
| Rate for Payer: Zelis Auto |
$1,020.80
|
| Rate for Payer: Zelis Worker's Compensation |
$696.70
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
OP
|
$2,552.00
|
|
|
Service Code
|
CPT 31291
|
| Hospital Charge Code |
6131291
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$638.00 |
| Max. Negotiated Rate |
$2,424.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,531.20
|
| Rate for Payer: Cash Price |
$1,531.20
|
| Rate for Payer: Cigna Commercial |
$2,169.20
|
| Rate for Payer: First Health Commercial |
$2,296.80
|
| Rate for Payer: First Health Workers Compensation |
$985.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,296.80
|
| Rate for Payer: GEHA Commercial |
$2,041.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,296.80
|
| Rate for Payer: Humana ChoiceCare |
$663.52
|
| Rate for Payer: Multiplan All |
$2,322.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,531.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,786.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,296.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,424.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,914.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,245.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$638.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,373.36
|
| Rate for Payer: Zelis Auto |
$1,020.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,276.00
|
| Rate for Payer: Zelis Worker's Compensation |
$696.70
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
CPT 31292
|
| Hospital Charge Code |
6131292
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$562.38 |
| Max. Negotiated Rate |
$1,957.00 |
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cigna Commercial |
$1,751.00
|
| Rate for Payer: First Health Commercial |
$1,854.00
|
| Rate for Payer: First Health Workers Compensation |
$795.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,854.00
|
| Rate for Payer: GEHA Commercial |
$1,442.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,854.00
|
| Rate for Payer: Multiplan All |
$1,874.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,442.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,854.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,957.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,545.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,915.80
|
| Rate for Payer: Zelis Auto |
$824.00
|
| Rate for Payer: Zelis Worker's Compensation |
$562.38
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT 31287
|
| Hospital Charge Code |
6131287
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$164.07 |
| Max. Negotiated Rate |
$570.95 |
| Rate for Payer: Cash Price |
$360.60
|
| Rate for Payer: Cigna Commercial |
$510.85
|
| Rate for Payer: First Health Commercial |
$540.90
|
| Rate for Payer: First Health Workers Compensation |
$232.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$540.90
|
| Rate for Payer: GEHA Commercial |
$420.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$540.90
|
| Rate for Payer: Multiplan All |
$546.91
|
| Rate for Payer: OMNI Networks Commercial |
$420.70
|
| Rate for Payer: One Health Plan PPO/POS |
$540.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$570.95
|
| Rate for Payer: Three Rivers Provider Network All |
$450.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$558.93
|
| Rate for Payer: Zelis Auto |
$240.40
|
| Rate for Payer: Zelis Worker's Compensation |
$164.07
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
IP
|
$2,560.00
|
|
|
Service Code
|
CPT 31294
|
| Hospital Charge Code |
6131294
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$698.88 |
| Max. Negotiated Rate |
$2,432.00 |
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cigna Commercial |
$2,176.00
|
| Rate for Payer: First Health Commercial |
$2,304.00
|
| Rate for Payer: First Health Workers Compensation |
$988.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,304.00
|
| Rate for Payer: GEHA Commercial |
$1,792.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,304.00
|
| Rate for Payer: Multiplan All |
$2,329.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,792.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,304.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,432.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,920.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,380.80
|
| Rate for Payer: Zelis Auto |
$1,024.00
|
| Rate for Payer: Zelis Worker's Compensation |
$698.88
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
OP
|
$2,560.00
|
|
|
Service Code
|
CPT 31294
|
| Hospital Charge Code |
6131294
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$698.88 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cigna Commercial |
$2,176.00
|
| Rate for Payer: First Health Commercial |
$2,304.00
|
| Rate for Payer: First Health Workers Compensation |
$988.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,304.00
|
| Rate for Payer: GEHA Commercial |
$2,048.00
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,304.00
|
| Rate for Payer: Humana ChoiceCare |
$7,230.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,573.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,042.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,392.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$2,329.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,792.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,304.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,762.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,392.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,432.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,920.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,392.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,380.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$1,024.00
|
| Rate for Payer: Zelis Medicare |
$5,587.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,887.79
|
| Rate for Payer: Zelis Worker's Compensation |
$698.88
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
IP
|
$2,237.00
|
|
|
Service Code
|
CPT 31293
|
| Hospital Charge Code |
6131293
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$610.70 |
| Max. Negotiated Rate |
$2,125.15 |
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Cigna Commercial |
$1,901.45
|
| Rate for Payer: First Health Commercial |
$2,013.30
|
| Rate for Payer: First Health Workers Compensation |
$863.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,013.30
|
| Rate for Payer: GEHA Commercial |
$1,565.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,013.30
|
| Rate for Payer: Multiplan All |
$2,035.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,565.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,013.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,125.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,677.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,080.41
|
| Rate for Payer: Zelis Auto |
$894.80
|
| Rate for Payer: Zelis Worker's Compensation |
$610.70
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
CPT 31292
|
| Hospital Charge Code |
6131292
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$562.38 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,236.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cigna Commercial |
$1,751.00
|
| Rate for Payer: First Health Commercial |
$1,854.00
|
| Rate for Payer: First Health Workers Compensation |
$795.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,854.00
|
| Rate for Payer: GEHA Commercial |
$1,648.00
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,854.00
|
| Rate for Payer: Humana ChoiceCare |
$7,230.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,573.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,042.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,392.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$1,874.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,442.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,854.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,762.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,392.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,957.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,545.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,392.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,915.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$824.00
|
| Rate for Payer: Zelis Medicare |
$5,587.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,887.79
|
| Rate for Payer: Zelis Worker's Compensation |
$562.38
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
CPT 31290
|
| Hospital Charge Code |
6131290
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$596.75 |
| Max. Negotiated Rate |
$2,267.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,432.20
|
| Rate for Payer: Cash Price |
$1,432.20
|
| Rate for Payer: Cigna Commercial |
$2,028.95
|
| Rate for Payer: First Health Commercial |
$2,148.30
|
| Rate for Payer: First Health Workers Compensation |
$921.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,148.30
|
| Rate for Payer: GEHA Commercial |
$1,909.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,148.30
|
| Rate for Payer: Humana ChoiceCare |
$620.62
|
| Rate for Payer: Multiplan All |
$2,172.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,432.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,670.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,148.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,267.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,790.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,100.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$596.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,219.91
|
| Rate for Payer: Zelis Auto |
$954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,193.50
|
| Rate for Payer: Zelis Worker's Compensation |
$651.65
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
CPT 31290
|
| Hospital Charge Code |
6131290
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$651.65 |
| Max. Negotiated Rate |
$2,267.65 |
| Rate for Payer: Cash Price |
$1,432.20
|
| Rate for Payer: Cigna Commercial |
$2,028.95
|
| Rate for Payer: First Health Commercial |
$2,148.30
|
| Rate for Payer: First Health Workers Compensation |
$921.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,148.30
|
| Rate for Payer: GEHA Commercial |
$1,670.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,148.30
|
| Rate for Payer: Multiplan All |
$2,172.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,670.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,148.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,267.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,790.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,219.91
|
| Rate for Payer: Zelis Auto |
$954.80
|
| Rate for Payer: Zelis Worker's Compensation |
$651.65
|
|
