|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 31288
|
| Hospital Charge Code |
6131288
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$190.01 |
| 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 |
$417.60
|
| 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 |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$556.80
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| 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 |
$633.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| 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 |
$661.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| 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 |
$647.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$278.40
|
| 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 |
$190.01
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 31240
|
| Hospital Charge Code |
6131240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$136.23 |
| 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 |
$299.40
|
| 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 |
$299.40
|
| Rate for Payer: Cash Price |
$299.40
|
| Rate for Payer: Cigna Commercial |
$424.15
|
| Rate for Payer: First Health Commercial |
$449.10
|
| Rate for Payer: First Health Workers Compensation |
$192.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$449.10
|
| Rate for Payer: GEHA Commercial |
$399.20
|
| Rate for Payer: GEHA Medicare |
$1,637.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$449.10
|
| 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 |
$454.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,783.66
|
| Rate for Payer: OMNI Networks Commercial |
$349.30
|
| Rate for Payer: One Health Plan PPO/POS |
$449.10
|
| 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 |
$474.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$374.25
|
| 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 |
$464.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,637.45
|
| Rate for Payer: Zelis Auto |
$199.60
|
| 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 |
$136.23
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
IP
|
$1,247.00
|
|
|
Service Code
|
CPT 31239
|
| Hospital Charge Code |
6131239
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.43 |
| Max. Negotiated Rate |
$1,184.65 |
| 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 |
$872.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,122.30
|
| Rate for Payer: Multiplan All |
$1,134.77
|
| Rate for Payer: OMNI Networks Commercial |
$872.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,122.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,184.65
|
| Rate for Payer: Three Rivers Provider Network All |
$935.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,159.71
|
| Rate for Payer: Zelis Auto |
$498.80
|
| Rate for Payer: Zelis Worker's Compensation |
$340.43
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
OP
|
$2,237.00
|
|
|
Service Code
|
CPT 31293
|
| Hospital Charge Code |
6131293
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$610.70 |
| 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 |
$1,342.20
|
| 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 |
$6,573.16
|
| Rate for Payer: Cash Price |
$1,342.20
|
| 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 |
$1,789.60
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,013.30
|
| 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 |
$2,035.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,565.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,013.30
|
| 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 |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,125.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,677.75
|
| 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 |
$2,080.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$894.80
|
| 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 |
$610.70
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
6131238
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.05 |
| Max. Negotiated Rate |
$497.80 |
| 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 |
$366.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$471.60
|
| Rate for Payer: Multiplan All |
$476.84
|
| Rate for Payer: OMNI Networks Commercial |
$366.80
|
| Rate for Payer: One Health Plan PPO/POS |
$471.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$497.80
|
| Rate for Payer: Three Rivers Provider Network All |
$393.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$487.32
|
| Rate for Payer: Zelis Auto |
$209.60
|
| Rate for Payer: Zelis Worker's Compensation |
$143.05
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 31288
|
| Hospital Charge Code |
6131288
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$190.01 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Worker's Compensation |
$190.01
|
|
|
NASAL/SINUS ENDOSCOPY SURG
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 31240
|
| Hospital Charge Code |
6131240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$136.23 |
| Max. Negotiated Rate |
$474.05 |
| Rate for Payer: Cash Price |
$299.40
|
| Rate for Payer: Cigna Commercial |
$424.15
|
| Rate for Payer: First Health Commercial |
$449.10
|
| Rate for Payer: First Health Workers Compensation |
$192.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$449.10
|
| Rate for Payer: GEHA Commercial |
$349.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$449.10
|
| Rate for Payer: Multiplan All |
$454.09
|
| Rate for Payer: OMNI Networks Commercial |
$349.30
|
| Rate for Payer: One Health Plan PPO/POS |
$449.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$474.05
|
| Rate for Payer: Three Rivers Provider Network All |
$374.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$464.07
|
| Rate for Payer: Zelis Auto |
$199.60
|
| Rate for Payer: Zelis Worker's Compensation |
$136.23
|
|
|
NASAL/SINUS NDSC SURG W/DILATION FRONTAL
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 31296
|
| Hospital Charge Code |
6131296
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.25 |
| Max. Negotiated Rate |
$536.75 |
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$480.25
|
| Rate for Payer: First Health Commercial |
$508.50
|
| Rate for Payer: First Health Workers Compensation |
$218.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$508.50
|
| Rate for Payer: GEHA Commercial |
$395.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$508.50
|
| Rate for Payer: Multiplan All |
$514.15
|
| Rate for Payer: OMNI Networks Commercial |
$395.50
|
| Rate for Payer: One Health Plan PPO/POS |
$508.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$536.75
|
| Rate for Payer: Three Rivers Provider Network All |
$423.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$525.45
|
| Rate for Payer: Zelis Auto |
$226.00
|
| Rate for Payer: Zelis Worker's Compensation |
$154.25
|
|
|
NASAL/SINUS NDSC SURG W/DILATION FRONTAL
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 31296
|
| Hospital Charge Code |
6131296
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.25 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$339.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,478.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$480.25
|
| Rate for Payer: First Health Commercial |
$508.50
|
| Rate for Payer: First Health Workers Compensation |
$218.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$508.50
|
| Rate for Payer: GEHA Commercial |
$452.00
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$508.50
|
| 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 |
$2,529.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$514.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$395.50
|
| Rate for Payer: One Health Plan PPO/POS |
$508.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,920.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,529.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$536.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$423.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,529.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$525.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$226.00
|
| 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 |
$154.25
|
|
|
NASAL/SINUS NDSC SURG W/DILATION FRONTAL
|
Facility
|
OP
|
$5,739.00
|
|
|
Service Code
|
CPT 31296
|
| Hospital Charge Code |
7931296
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,566.75 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,443.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,478.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$3,443.40
|
| Rate for Payer: Cash Price |
$3,443.40
|
| Rate for Payer: Cigna Commercial |
$4,878.15
|
| Rate for Payer: First Health Commercial |
$5,165.10
|
| Rate for Payer: First Health Workers Compensation |
$2,215.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,165.10
|
| Rate for Payer: GEHA Commercial |
$4,591.20
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,165.10
|
| 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 |
$2,529.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$5,222.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$4,017.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,165.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,920.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,529.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,452.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$4,304.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,529.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,337.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$2,295.60
|
| 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 |
$1,566.75
|
|
|
NASAL/SINUS NDSC SURG W/DILATION FRONTAL
|
Facility
|
IP
|
$5,739.00
|
|
|
Service Code
|
CPT 31296
|
| Hospital Charge Code |
7931296
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,566.75 |
| Max. Negotiated Rate |
$5,452.05 |
| Rate for Payer: Cash Price |
$3,443.40
|
| Rate for Payer: Cigna Commercial |
$4,878.15
|
| Rate for Payer: First Health Commercial |
$5,165.10
|
| Rate for Payer: First Health Workers Compensation |
$2,215.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,165.10
|
| Rate for Payer: GEHA Commercial |
$4,017.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,165.10
|
| Rate for Payer: Multiplan All |
$5,222.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,017.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,165.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,452.05
|
| Rate for Payer: Three Rivers Provider Network All |
$4,304.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,337.27
|
| Rate for Payer: Zelis Auto |
$2,295.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,566.75
|
|
|
NASAL/SINUS NDSC SURG W/DILATION FRONTAL
|
Facility
|
IP
|
$5,739.00
|
|
|
Service Code
|
CPT 31296
|
| Hospital Charge Code |
8300046
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,566.75 |
| Max. Negotiated Rate |
$5,452.05 |
| Rate for Payer: Cash Price |
$3,443.40
|
| Rate for Payer: Cigna Commercial |
$4,878.15
|
| Rate for Payer: First Health Commercial |
$5,165.10
|
| Rate for Payer: First Health Workers Compensation |
$2,215.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,165.10
|
| Rate for Payer: GEHA Commercial |
$4,017.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,165.10
|
| Rate for Payer: Multiplan All |
$5,222.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,017.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,165.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,452.05
|
| Rate for Payer: Three Rivers Provider Network All |
$4,304.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,337.27
|
| Rate for Payer: Zelis Auto |
$2,295.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,566.75
|
|
|
NASAL/SINUS NDSC SURG W/DILATION FRONTAL
|
Facility
|
OP
|
$5,739.00
|
|
|
Service Code
|
CPT 31296
|
| Hospital Charge Code |
8300046
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,566.75 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,443.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,478.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$3,443.40
|
| Rate for Payer: Cash Price |
$3,443.40
|
| Rate for Payer: Cigna Commercial |
$4,878.15
|
| Rate for Payer: First Health Commercial |
$5,165.10
|
| Rate for Payer: First Health Workers Compensation |
$2,215.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,165.10
|
| Rate for Payer: GEHA Commercial |
$4,591.20
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,165.10
|
| 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 |
$2,529.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$5,222.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$4,017.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,165.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,920.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,529.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,452.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$4,304.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,529.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,337.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$2,295.60
|
| 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 |
$1,566.75
|
|
|
NASAL/SINUS NDSC SURG W/DILATION MAXILLA
|
Facility
|
IP
|
$5,660.00
|
|
|
Service Code
|
CPT 31295
|
| Hospital Charge Code |
8300045
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,545.18 |
| Max. Negotiated Rate |
$5,377.00 |
| Rate for Payer: Cash Price |
$3,396.00
|
| Rate for Payer: Cigna Commercial |
$4,811.00
|
| Rate for Payer: First Health Commercial |
$5,094.00
|
| Rate for Payer: First Health Workers Compensation |
$2,185.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,094.00
|
| Rate for Payer: GEHA Commercial |
$3,962.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,094.00
|
| Rate for Payer: Multiplan All |
$5,150.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,962.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,094.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,377.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,245.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,263.80
|
| Rate for Payer: Zelis Auto |
$2,264.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,545.18
|
|
|
NASAL/SINUS NDSC SURG W/DILATION MAXILLA
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 31295
|
| Hospital Charge Code |
6131295
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$472.15 |
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cigna Commercial |
$422.45
|
| Rate for Payer: First Health Commercial |
$447.30
|
| Rate for Payer: First Health Workers Compensation |
$191.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$447.30
|
| Rate for Payer: GEHA Commercial |
$347.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$447.30
|
| Rate for Payer: Multiplan All |
$452.27
|
| Rate for Payer: OMNI Networks Commercial |
$347.90
|
| Rate for Payer: One Health Plan PPO/POS |
$447.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$472.15
|
| Rate for Payer: Three Rivers Provider Network All |
$372.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$462.21
|
| Rate for Payer: Zelis Auto |
$198.80
|
| Rate for Payer: Zelis Worker's Compensation |
$135.68
|
|
|
NASAL/SINUS NDSC SURG W/DILATION MAXILLA
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 31295
|
| Hospital Charge Code |
6131295
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,478.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cigna Commercial |
$422.45
|
| Rate for Payer: First Health Commercial |
$447.30
|
| Rate for Payer: First Health Workers Compensation |
$191.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$447.30
|
| Rate for Payer: GEHA Commercial |
$397.60
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$447.30
|
| 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 |
$2,529.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$452.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$347.90
|
| Rate for Payer: One Health Plan PPO/POS |
$447.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,920.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,529.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$472.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$372.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,529.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$462.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$198.80
|
| 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 |
$135.68
|
|
|
NASAL/SINUS NDSC SURG W/DILATION MAXILLA
|
Facility
|
OP
|
$5,660.00
|
|
|
Service Code
|
CPT 31295
|
| Hospital Charge Code |
8300045
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,545.18 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,396.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,478.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$3,396.00
|
| Rate for Payer: Cash Price |
$3,396.00
|
| Rate for Payer: Cigna Commercial |
$4,811.00
|
| Rate for Payer: First Health Commercial |
$5,094.00
|
| Rate for Payer: First Health Workers Compensation |
$2,185.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,094.00
|
| Rate for Payer: GEHA Commercial |
$4,528.00
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,094.00
|
| 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 |
$2,529.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$5,150.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$3,962.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,094.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,920.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,529.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,377.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$4,245.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,529.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,263.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$2,264.00
|
| 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 |
$1,545.18
|
|
|
NASAL/SINUS NDSC SURG W/DILATION SPHENOI
|
Facility
|
OP
|
$5,616.00
|
|
|
Service Code
|
CPT 31297
|
| Hospital Charge Code |
8300047
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,533.17 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,369.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,478.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cigna Commercial |
$4,773.60
|
| Rate for Payer: First Health Commercial |
$5,054.40
|
| Rate for Payer: First Health Workers Compensation |
$2,168.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,054.40
|
| Rate for Payer: GEHA Commercial |
$4,492.80
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,054.40
|
| 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 |
$2,529.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$5,110.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$3,931.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,054.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,920.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,529.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,335.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$4,212.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,529.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,222.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$2,246.40
|
| 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 |
$1,533.17
|
|
|
NASAL/SINUS NDSC SURG W/DILATION SPHENOI
|
Facility
|
IP
|
$5,616.00
|
|
|
Service Code
|
CPT 31297
|
| Hospital Charge Code |
8300047
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,533.17 |
| Max. Negotiated Rate |
$5,335.20 |
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cigna Commercial |
$4,773.60
|
| Rate for Payer: First Health Commercial |
$5,054.40
|
| Rate for Payer: First Health Workers Compensation |
$2,168.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,054.40
|
| Rate for Payer: GEHA Commercial |
$3,931.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,054.40
|
| Rate for Payer: Multiplan All |
$5,110.56
|
| Rate for Payer: OMNI Networks Commercial |
$3,931.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,054.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,335.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,212.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,222.88
|
| Rate for Payer: Zelis Auto |
$2,246.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,533.17
|
|
|
NASAL/SINUS NDSC SURG W/DILATION SPHENOI
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 31297
|
| Hospital Charge Code |
6131297
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$123.40 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$271.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,128.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,478.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: First Health Workers Compensation |
$174.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$361.60
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| 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 |
$2,529.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,920.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,529.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,529.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$180.80
|
| 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 |
$123.40
|
|
|
NASAL/SINUS NDSC SURG W/DILATION SPHENOI
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 31297
|
| Hospital Charge Code |
6131297
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$123.40 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: First Health Workers Compensation |
$174.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$316.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Worker's Compensation |
$123.40
|
|
|
NASAL SINUS THERAPY
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 30210
|
| Hospital Charge Code |
6130210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$255.00
|
| Rate for Payer: First Health Commercial |
$270.00
|
| Rate for Payer: First Health Workers Compensation |
$115.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.00
|
| Rate for Payer: GEHA Commercial |
$210.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.00
|
| Rate for Payer: Multiplan All |
$273.00
|
| Rate for Payer: OMNI Networks Commercial |
$210.00
|
| Rate for Payer: One Health Plan PPO/POS |
$270.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.00
|
| Rate for Payer: Three Rivers Provider Network All |
$225.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.00
|
| Rate for Payer: Zelis Auto |
$120.00
|
| Rate for Payer: Zelis Worker's Compensation |
$81.90
|
|
|
NASAL SINUS THERAPY
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 30210
|
| Hospital Charge Code |
6130210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$255.00
|
| Rate for Payer: First Health Commercial |
$270.00
|
| Rate for Payer: First Health Workers Compensation |
$115.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.00
|
| Rate for Payer: GEHA Commercial |
$240.00
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.00
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$273.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$210.00
|
| Rate for Payer: One Health Plan PPO/POS |
$270.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$225.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$120.00
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$81.90
|
|
|
NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUO
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
6143752
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: First Health Commercial |
$115.20
|
| Rate for Payer: First Health Workers Compensation |
$49.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$115.20
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$115.20
|
| Rate for Payer: Multiplan All |
$116.48
|
| Rate for Payer: OMNI Networks Commercial |
$89.60
|
| Rate for Payer: One Health Plan PPO/POS |
$115.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$121.60
|
| Rate for Payer: Three Rivers Provider Network All |
$96.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.04
|
| Rate for Payer: Zelis Auto |
$51.20
|
| Rate for Payer: Zelis Worker's Compensation |
$34.94
|
|
|
NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUO
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
1000034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.35 |
| Max. Negotiated Rate |
$902.50 |
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$807.50
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: First Health Workers Compensation |
$366.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$855.00
|
| Rate for Payer: GEHA Commercial |
$665.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$855.00
|
| Rate for Payer: Multiplan All |
$864.50
|
| Rate for Payer: OMNI Networks Commercial |
$665.00
|
| Rate for Payer: One Health Plan PPO/POS |
$855.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$902.50
|
| Rate for Payer: Three Rivers Provider Network All |
$712.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$883.50
|
| Rate for Payer: Zelis Auto |
$380.00
|
| Rate for Payer: Zelis Worker's Compensation |
$259.35
|
|
