|
ANESTHESIA MAC 1ST HOUR
|
Facility
|
IP
|
$1,594.00
|
|
| Hospital Charge Code |
3750011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$435.16 |
| Max. Negotiated Rate |
$1,514.30 |
| 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 |
$1,115.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,434.60
|
| Rate for Payer: Multiplan All |
$1,450.54
|
| 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: United Payors & United Providers UP&UP |
$1,482.42
|
| Rate for Payer: Zelis Auto |
$637.60
|
| Rate for Payer: Zelis Worker's Compensation |
$435.16
|
|
|
ANESTHESIA MAC 30"
|
Facility
|
IP
|
$743.00
|
|
| Hospital Charge Code |
3750004
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$202.84 |
| Max. Negotiated Rate |
$705.85 |
| Rate for Payer: Cash Price |
$445.80
|
| Rate for Payer: Cigna Commercial |
$631.55
|
| Rate for Payer: First Health Commercial |
$668.70
|
| Rate for Payer: First Health Workers Compensation |
$286.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$668.70
|
| Rate for Payer: GEHA Commercial |
$520.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$668.70
|
| Rate for Payer: Multiplan All |
$676.13
|
| Rate for Payer: OMNI Networks Commercial |
$520.10
|
| Rate for Payer: One Health Plan PPO/POS |
$668.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$705.85
|
| Rate for Payer: Three Rivers Provider Network All |
$557.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$690.99
|
| Rate for Payer: Zelis Auto |
$297.20
|
| Rate for Payer: Zelis Worker's Compensation |
$202.84
|
|
|
ANESTHESIA MAC 30"
|
Facility
|
OP
|
$743.00
|
|
| Hospital Charge Code |
3750004
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$185.75 |
| Max. Negotiated Rate |
$705.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$445.80
|
| Rate for Payer: Cash Price |
$445.80
|
| Rate for Payer: Cigna Commercial |
$631.55
|
| Rate for Payer: First Health Commercial |
$668.70
|
| Rate for Payer: First Health Workers Compensation |
$286.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$668.70
|
| Rate for Payer: GEHA Commercial |
$594.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$668.70
|
| Rate for Payer: Humana ChoiceCare |
$193.18
|
| Rate for Payer: Multiplan All |
$676.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$445.80
|
| Rate for Payer: OMNI Networks Commercial |
$520.10
|
| Rate for Payer: One Health Plan PPO/POS |
$668.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$705.85
|
| Rate for Payer: Three Rivers Provider Network All |
$557.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$653.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$185.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$690.99
|
| Rate for Payer: Zelis Auto |
$297.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$371.50
|
| Rate for Payer: Zelis Worker's Compensation |
$202.84
|
|
|
ANESTHESIA MAC ADD 15 MINS
|
Facility
|
IP
|
$376.00
|
|
| Hospital Charge Code |
3750005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$102.65 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: First Health Workers Compensation |
$145.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
| Rate for Payer: Zelis Worker's Compensation |
$102.65
|
|
|
ANESTHESIA MAC ADD 15 MINS
|
Facility
|
OP
|
$376.00
|
|
| Hospital Charge Code |
3750005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: First Health Workers Compensation |
$145.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$300.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Humana ChoiceCare |
$97.76
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$225.60
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$330.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$188.00
|
| Rate for Payer: Zelis Worker's Compensation |
$102.65
|
|
|
ANESTHESIA REG 30"
|
Facility
|
IP
|
$806.00
|
|
| Hospital Charge Code |
3750006
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$220.04 |
| Max. Negotiated Rate |
$765.70 |
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Cigna Commercial |
$685.10
|
| Rate for Payer: First Health Commercial |
$725.40
|
| Rate for Payer: First Health Workers Compensation |
$311.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$725.40
|
| Rate for Payer: GEHA Commercial |
$564.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$725.40
|
| Rate for Payer: Multiplan All |
$733.46
|
| Rate for Payer: OMNI Networks Commercial |
$564.20
|
| Rate for Payer: One Health Plan PPO/POS |
$725.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$765.70
|
| Rate for Payer: Three Rivers Provider Network All |
$604.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$749.58
|
| Rate for Payer: Zelis Auto |
$322.40
|
| Rate for Payer: Zelis Worker's Compensation |
$220.04
|
|
|
ANESTHESIA REG 30"
|
Facility
|
OP
|
$806.00
|
|
| Hospital Charge Code |
3750006
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$765.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$483.60
|
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Cigna Commercial |
$685.10
|
| Rate for Payer: First Health Commercial |
$725.40
|
| Rate for Payer: First Health Workers Compensation |
$311.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$725.40
|
| Rate for Payer: GEHA Commercial |
$644.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$725.40
|
| Rate for Payer: Humana ChoiceCare |
$209.56
|
| Rate for Payer: Multiplan All |
$733.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$483.60
|
| Rate for Payer: OMNI Networks Commercial |
$564.20
|
| Rate for Payer: One Health Plan PPO/POS |
$725.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$765.70
|
| Rate for Payer: Three Rivers Provider Network All |
$604.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$709.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$201.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$749.58
|
| Rate for Payer: Zelis Auto |
$322.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$403.00
|
| Rate for Payer: Zelis Worker's Compensation |
$220.04
|
|
|
ANESTHESIA/SALIVARY/BIOPSY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00100
|
| Hospital Charge Code |
3700100
|
|
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/SALIVARY/BIOPSY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00100
|
| Hospital Charge Code |
3700100
|
|
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 UPPER GI ENDOSCOPIC PX ERCP
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 00732
|
| Hospital Charge Code |
3700732
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
ANESTHESIA UPPER GI ENDOSCOPIC PX ERCP
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 00732
|
| Hospital Charge Code |
3700732
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$132.08
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$304.80
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$447.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$254.00
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
ANESTHESIA UPPER GI ENDOSCOPIC PX NOS
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00731
|
| Hospital Charge Code |
3700740
|
|
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 UPPER GI ENDOSCOPIC PX NOS
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 00731
|
| Hospital Charge Code |
3700731
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$132.08
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$304.80
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$447.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$254.00
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
ANESTHESIA UPPER GI ENDOSCOPIC PX NOS
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00731
|
| Hospital Charge Code |
3700740
|
|
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 UPPER GI ENDOSCOPIC PX NOS
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 00731
|
| Hospital Charge Code |
3700731
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
ANESTH EX MID INNER EAR W/BIOPSY NOS
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00120
|
| Hospital Charge Code |
3700120
|
|
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 EX MID INNER EAR W/BIOPSY NOS
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00120
|
| Hospital Charge Code |
3700120
|
|
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 FACE/SKULL BONE SURG
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00190
|
| Hospital Charge Code |
3700190
|
|
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 FACE/SKULL BONE SURG
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00190
|
| Hospital Charge Code |
3700190
|
|
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 FOR LIVER BIOPSY
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 00702
|
| Hospital Charge Code |
3700702
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: First Health Workers Compensation |
$42.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$88.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Humana ChoiceCare |
$28.60
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$66.00
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$96.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$55.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.03
|
|
|
ANESTH FOR LIVER BIOPSY
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 00702
|
| Hospital Charge Code |
3700702
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: First Health Workers Compensation |
$42.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$77.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.03
|
|
|
ANESTH FOR NON INVASIVE IMAGING OR RAD
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 01922
|
| Hospital Charge Code |
3701995
|
|
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 FOR NON INVASIVE IMAGING OR RAD
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 01922
|
| Hospital Charge Code |
3701995
|
|
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 GENITALIA SURGERY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00920
|
| Hospital Charge Code |
3700920
|
|
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 GENITALIA SURGERY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00920
|
| Hospital Charge Code |
3700920
|
|
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
|
|
