|
ANES OTOSCOPY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00124
|
| Hospital Charge Code |
3700124
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANES REPAIR CLEFT PALATE
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00172
|
| Hospital Charge Code |
3700172
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANES REPAIR CLEFT PALATE
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00172
|
| Hospital Charge Code |
3700172
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANESTH ABDOMINAL WALL SURG
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 00700
|
| Hospital Charge Code |
3700700
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$166.25 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: First Health Workers Compensation |
$256.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$532.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| Rate for Payer: Humana ChoiceCare |
$172.90
|
| Rate for Payer: Multiplan All |
$605.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$399.00
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$631.75
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$585.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$166.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$618.45
|
| Rate for Payer: Zelis Auto |
$266.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$332.50
|
| Rate for Payer: Zelis Worker's Compensation |
$181.54
|
|
|
ANESTH ABDOMINAL WALL SURG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 00800
|
| Hospital Charge Code |
3700800
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$159.50 |
| Max. Negotiated Rate |
$606.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$382.80
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$542.30
|
| Rate for Payer: First Health Commercial |
$574.20
|
| Rate for Payer: First Health Workers Compensation |
$246.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$574.20
|
| Rate for Payer: GEHA Commercial |
$510.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$574.20
|
| Rate for Payer: Humana ChoiceCare |
$165.88
|
| Rate for Payer: Multiplan All |
$580.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$382.80
|
| Rate for Payer: OMNI Networks Commercial |
$446.60
|
| Rate for Payer: One Health Plan PPO/POS |
$574.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$606.10
|
| Rate for Payer: Three Rivers Provider Network All |
$478.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$561.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$593.34
|
| Rate for Payer: Zelis Auto |
$255.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$319.00
|
| Rate for Payer: Zelis Worker's Compensation |
$174.17
|
|
|
ANESTH ABDOMINAL WALL SURG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 00800
|
| Hospital Charge Code |
3700800
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$174.17 |
| Max. Negotiated Rate |
$606.10 |
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$542.30
|
| Rate for Payer: First Health Commercial |
$574.20
|
| Rate for Payer: First Health Workers Compensation |
$246.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$574.20
|
| Rate for Payer: GEHA Commercial |
$446.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$574.20
|
| Rate for Payer: Multiplan All |
$580.58
|
| Rate for Payer: OMNI Networks Commercial |
$446.60
|
| Rate for Payer: One Health Plan PPO/POS |
$574.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$606.10
|
| Rate for Payer: Three Rivers Provider Network All |
$478.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$593.34
|
| Rate for Payer: Zelis Auto |
$255.20
|
| Rate for Payer: Zelis Worker's Compensation |
$174.17
|
|
|
ANESTH ABDOMINAL WALL SURG
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 00700
|
| Hospital Charge Code |
3700700
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$181.54 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: First Health Workers Compensation |
$256.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$465.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| Rate for Payer: Multiplan All |
$605.15
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$631.75
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$618.45
|
| Rate for Payer: Zelis Auto |
$266.00
|
| Rate for Payer: Zelis Worker's Compensation |
$181.54
|
|
|
ANESTH ABDOMINAL WALL SURG
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00820
|
| Hospital Charge Code |
3700820
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANESTH ABDOMINAL WALL SURG
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00820
|
| Hospital Charge Code |
3700820
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANESTH ACHILLES TENDON SURG
|
Facility
|
IP
|
$1,047.00
|
|
|
Service Code
|
CPT 01472
|
| Hospital Charge Code |
3701472
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$285.83 |
| Max. Negotiated Rate |
$994.65 |
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Cigna Commercial |
$889.95
|
| Rate for Payer: First Health Commercial |
$942.30
|
| Rate for Payer: First Health Workers Compensation |
$404.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$942.30
|
| Rate for Payer: GEHA Commercial |
$732.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$942.30
|
| Rate for Payer: Multiplan All |
$952.77
|
| Rate for Payer: OMNI Networks Commercial |
$732.90
|
| Rate for Payer: One Health Plan PPO/POS |
$942.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$994.65
|
| Rate for Payer: Three Rivers Provider Network All |
$785.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$973.71
|
| Rate for Payer: Zelis Auto |
$418.80
|
| Rate for Payer: Zelis Worker's Compensation |
$285.83
|
|
|
ANESTH ACHILLES TENDON SURG
|
Facility
|
OP
|
$1,047.00
|
|
|
Service Code
|
CPT 01472
|
| Hospital Charge Code |
3701472
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$261.75 |
| Max. Negotiated Rate |
$994.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$628.20
|
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Cigna Commercial |
$889.95
|
| Rate for Payer: First Health Commercial |
$942.30
|
| Rate for Payer: First Health Workers Compensation |
$404.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$942.30
|
| Rate for Payer: GEHA Commercial |
$837.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$942.30
|
| Rate for Payer: Humana ChoiceCare |
$272.22
|
| Rate for Payer: Multiplan All |
$952.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$628.20
|
| Rate for Payer: OMNI Networks Commercial |
$732.90
|
| Rate for Payer: One Health Plan PPO/POS |
$942.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$994.65
|
| Rate for Payer: Three Rivers Provider Network All |
$785.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$921.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$261.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$973.71
|
| Rate for Payer: Zelis Auto |
$418.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$523.50
|
| Rate for Payer: Zelis Worker's Compensation |
$285.83
|
|
|
ANESTH ANKLE/FT ARTHROSCOPY
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
CPT 01464
|
| Hospital Charge Code |
3701464
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$485.45 |
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$434.35
|
| Rate for Payer: First Health Commercial |
$459.90
|
| Rate for Payer: First Health Workers Compensation |
$197.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.90
|
| Rate for Payer: GEHA Commercial |
$357.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.90
|
| Rate for Payer: Multiplan All |
$465.01
|
| Rate for Payer: OMNI Networks Commercial |
$357.70
|
| Rate for Payer: One Health Plan PPO/POS |
$459.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$485.45
|
| Rate for Payer: Three Rivers Provider Network All |
$383.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$475.23
|
| Rate for Payer: Zelis Auto |
$204.40
|
| Rate for Payer: Zelis Worker's Compensation |
$139.50
|
|
|
ANESTH ANKLE/FT ARTHROSCOPY
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
CPT 01464
|
| Hospital Charge Code |
3701464
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$127.75 |
| Max. Negotiated Rate |
$485.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$306.60
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$434.35
|
| Rate for Payer: First Health Commercial |
$459.90
|
| Rate for Payer: First Health Workers Compensation |
$197.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.90
|
| Rate for Payer: GEHA Commercial |
$408.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.90
|
| Rate for Payer: Humana ChoiceCare |
$132.86
|
| Rate for Payer: Multiplan All |
$465.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$306.60
|
| Rate for Payer: OMNI Networks Commercial |
$357.70
|
| Rate for Payer: One Health Plan PPO/POS |
$459.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$485.45
|
| Rate for Payer: Three Rivers Provider Network All |
$383.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$449.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$475.23
|
| Rate for Payer: Zelis Auto |
$204.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$255.50
|
| Rate for Payer: Zelis Worker's Compensation |
$139.50
|
|
|
ANESTH ANORECTAL SURGERY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00902
|
| Hospital Charge Code |
3700902
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANESTH ANORECTAL SURGERY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00902
|
| Hospital Charge Code |
3700902
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANESTH BICEPS TENDON REPAIR
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 01716
|
| Hospital Charge Code |
3701716
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANESTH BICEPS TENDON REPAIR
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 01716
|
| Hospital Charge Code |
3701716
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANESTH BICEPS TENDON REPAIR
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 01620
|
| Hospital Charge Code |
3701620
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANESTH BICEPS TENDON REPAIR
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 01620
|
| Hospital Charge Code |
3701620
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANESTH BIOPSY OF NOSE
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT 00164
|
| Hospital Charge Code |
3700164
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$288.01 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: First Health Workers Compensation |
$407.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$738.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Worker's Compensation |
$288.01
|
|
|
ANESTH BIOPSY OF NOSE
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT 00164
|
| Hospital Charge Code |
3700164
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$263.75 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: First Health Workers Compensation |
$407.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$844.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Humana ChoiceCare |
$274.30
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$633.00
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$928.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.50
|
| Rate for Payer: Zelis Worker's Compensation |
$288.01
|
|
|
ANESTH BIOPSY OF THYROID
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00322
|
| Hospital Charge Code |
3700322
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANESTH BIOPSY OF THYROID
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00322
|
| Hospital Charge Code |
3700322
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANESTH BLADDER SURGERY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00910
|
| Hospital Charge Code |
3700910
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
ANESTH BLADDER SURGERY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00910
|
| Hospital Charge Code |
3700910
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
