|
ANESTH BODY CAST PROCEDURE
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 01130
|
| Hospital Charge Code |
3701130
|
|
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 BODY CAST PROCEDURE
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 01130
|
| Hospital Charge Code |
3701130
|
|
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 CHEST PROCEDURE
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00520
|
| Hospital Charge Code |
3700520
|
|
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 CHEST PROCEDURE
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00520
|
| Hospital Charge Code |
3700520
|
|
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 COLPOTOMY VAGINECTOMY COLPORRHAPY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00942
|
| Hospital Charge Code |
3736626
|
|
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 COLPOTOMY VAGINECTOMY COLPORRHAPY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00942
|
| Hospital Charge Code |
3736626
|
|
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 COMBINED UPPER&LOWER GI ENDOS PX
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00813
|
| Hospital Charge Code |
3700813
|
|
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 COMBINED UPPER&LOWER GI ENDOS PX
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00813
|
| Hospital Charge Code |
3700813
|
|
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 ELBOW AREA SURGERY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 01710
|
| Hospital Charge Code |
3701710
|
|
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 ELBOW AREA SURGERY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 01710
|
| Hospital Charge Code |
3701710
|
|
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
|
|
|
ANESTHESIA GASES 1ST HOUR
|
Facility
|
OP
|
$325.00
|
|
| Hospital Charge Code |
3750012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: First Health Workers Compensation |
$125.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$260.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| Rate for Payer: Humana ChoiceCare |
$84.50
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$195.00
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$286.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: Zelis Auto |
$130.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.50
|
| Rate for Payer: Zelis Worker's Compensation |
$88.72
|
|
|
ANESTHESIA GASES 1ST HOUR
|
Facility
|
IP
|
$325.00
|
|
| Hospital Charge Code |
3750012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$88.72 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: First Health Workers Compensation |
$125.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$227.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: Zelis Auto |
$130.00
|
| Rate for Payer: Zelis Worker's Compensation |
$88.72
|
|
|
ANESTHESIA GASES ADD 15 MINUTE
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
3750008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$64.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$21.06
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.60
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$71.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$40.50
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
ANESTHESIA GASES ADD 15 MINUTE
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
3750008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$56.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
ANESTHESIA GEN 1ST HOUR
|
Facility
|
IP
|
$2,132.00
|
|
| Hospital Charge Code |
3750009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$582.04 |
| Max. Negotiated Rate |
$2,025.40 |
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cigna Commercial |
$1,812.20
|
| Rate for Payer: First Health Commercial |
$1,918.80
|
| Rate for Payer: First Health Workers Compensation |
$823.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,918.80
|
| Rate for Payer: GEHA Commercial |
$1,492.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,918.80
|
| Rate for Payer: Multiplan All |
$1,940.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,492.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,918.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,025.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,599.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,982.76
|
| Rate for Payer: Zelis Auto |
$852.80
|
| Rate for Payer: Zelis Worker's Compensation |
$582.04
|
|
|
ANESTHESIA GEN 1ST HOUR
|
Facility
|
OP
|
$2,132.00
|
|
| Hospital Charge Code |
3750009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$533.00 |
| Max. Negotiated Rate |
$2,025.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,279.20
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cigna Commercial |
$1,812.20
|
| Rate for Payer: First Health Commercial |
$1,918.80
|
| Rate for Payer: First Health Workers Compensation |
$823.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,918.80
|
| Rate for Payer: GEHA Commercial |
$1,705.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,918.80
|
| Rate for Payer: Humana ChoiceCare |
$554.32
|
| Rate for Payer: Multiplan All |
$1,940.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,279.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,492.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,918.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,025.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,599.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,876.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$533.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,982.76
|
| Rate for Payer: Zelis Auto |
$852.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,066.00
|
| Rate for Payer: Zelis Worker's Compensation |
$582.04
|
|
|
ANESTHESIA GEN 30"
|
Facility
|
OP
|
$1,185.00
|
|
| Hospital Charge Code |
3750002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$1,125.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$711.00
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cigna Commercial |
$1,007.25
|
| Rate for Payer: First Health Commercial |
$1,066.50
|
| Rate for Payer: First Health Workers Compensation |
$457.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,066.50
|
| Rate for Payer: GEHA Commercial |
$948.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,066.50
|
| Rate for Payer: Humana ChoiceCare |
$308.10
|
| Rate for Payer: Multiplan All |
$1,078.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$711.00
|
| Rate for Payer: OMNI Networks Commercial |
$829.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,066.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,125.75
|
| Rate for Payer: Three Rivers Provider Network All |
$888.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,042.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$296.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,102.05
|
| Rate for Payer: Zelis Auto |
$474.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$592.50
|
| Rate for Payer: Zelis Worker's Compensation |
$323.50
|
|
|
ANESTHESIA GEN 30"
|
Facility
|
IP
|
$1,185.00
|
|
| Hospital Charge Code |
3750002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$323.50 |
| Max. Negotiated Rate |
$1,125.75 |
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cigna Commercial |
$1,007.25
|
| Rate for Payer: First Health Commercial |
$1,066.50
|
| Rate for Payer: First Health Workers Compensation |
$457.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,066.50
|
| Rate for Payer: GEHA Commercial |
$829.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,066.50
|
| Rate for Payer: Multiplan All |
$1,078.35
|
| Rate for Payer: OMNI Networks Commercial |
$829.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,066.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,125.75
|
| Rate for Payer: Three Rivers Provider Network All |
$888.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,102.05
|
| Rate for Payer: Zelis Auto |
$474.00
|
| Rate for Payer: Zelis Worker's Compensation |
$323.50
|
|
|
ANESTHESIA GEN ADD 15 MIN
|
Facility
|
OP
|
$533.00
|
|
| Hospital Charge Code |
3750003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$506.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$453.05
|
| Rate for Payer: First Health Commercial |
$479.70
|
| Rate for Payer: First Health Workers Compensation |
$205.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$479.70
|
| Rate for Payer: GEHA Commercial |
$426.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$479.70
|
| Rate for Payer: Humana ChoiceCare |
$138.58
|
| Rate for Payer: Multiplan All |
$485.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$319.80
|
| Rate for Payer: OMNI Networks Commercial |
$373.10
|
| Rate for Payer: One Health Plan PPO/POS |
$479.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.35
|
| Rate for Payer: Three Rivers Provider Network All |
$399.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$469.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$133.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$495.69
|
| Rate for Payer: Zelis Auto |
$213.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$266.50
|
| Rate for Payer: Zelis Worker's Compensation |
$145.51
|
|
|
ANESTHESIA GEN ADD 15 MIN
|
Facility
|
IP
|
$533.00
|
|
| Hospital Charge Code |
3750003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$145.51 |
| Max. Negotiated Rate |
$506.35 |
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$453.05
|
| Rate for Payer: First Health Commercial |
$479.70
|
| Rate for Payer: First Health Workers Compensation |
$205.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$479.70
|
| Rate for Payer: GEHA Commercial |
$373.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$479.70
|
| Rate for Payer: Multiplan All |
$485.03
|
| Rate for Payer: OMNI Networks Commercial |
$373.10
|
| Rate for Payer: One Health Plan PPO/POS |
$479.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.35
|
| Rate for Payer: Three Rivers Provider Network All |
$399.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$495.69
|
| Rate for Payer: Zelis Auto |
$213.20
|
| Rate for Payer: Zelis Worker's Compensation |
$145.51
|
|
|
ANESTHESIA INTRAORAL W/BIOPSY NOS
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00170
|
| Hospital Charge Code |
3700170
|
|
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
|
|
|
ANESTHESIA INTRAORAL W/BIOPSY NOS
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00170
|
| Hospital Charge Code |
3700170
|
|
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
|
|
|
ANESTHESIA LOWER INTST ENDOSCOPIC PX NOS
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00811
|
| Hospital Charge Code |
3700810
|
|
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
|
|
|
ANESTHESIA LOWER INTST ENDOSCOPIC PX NOS
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00811
|
| Hospital Charge Code |
3700810
|
|
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
|
|
|
ANESTHESIA MAC 1ST HOUR
|
Facility
|
OP
|
$1,594.00
|
|
| Hospital Charge Code |
3750011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$398.50 |
| Max. Negotiated Rate |
$1,514.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$956.40
|
| Rate for Payer: Cash Price |
$956.40
|
| Rate for Payer: Cigna Commercial |
$1,354.90
|
| Rate for Payer: First Health Commercial |
$1,434.60
|
| Rate for Payer: First Health Workers Compensation |
$615.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,434.60
|
| Rate for Payer: GEHA Commercial |
$1,275.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,434.60
|
| Rate for Payer: Humana ChoiceCare |
$414.44
|
| Rate for Payer: Multiplan All |
$1,450.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$956.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,115.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,434.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,514.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,195.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,402.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$398.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,482.42
|
| Rate for Payer: Zelis Auto |
$637.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$797.00
|
| Rate for Payer: Zelis Worker's Compensation |
$435.16
|
|
