|
ANESTH TOTAL SHOULDER REPLACEMENT
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 01638
|
| Hospital Charge Code |
3701993
|
|
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 TOTAL SHOULDER REPLACEMENT
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 01638
|
| Hospital Charge Code |
3701993
|
|
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 UPPER ARM SURGERY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 01758
|
| Hospital Charge Code |
3701994
|
|
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 UPPER ARM SURGERY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 01758
|
| Hospital Charge Code |
3701994
|
|
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 UPPER ARM SURGERY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 01740
|
| Hospital Charge Code |
3701740
|
|
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 UPPER ARM SURGERY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 01740
|
| Hospital Charge Code |
3701740
|
|
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 UPPER LEG SURGERY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 01250
|
| Hospital Charge Code |
3701250
|
|
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 UPPER LEG SURGERY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 01250
|
| Hospital Charge Code |
3701250
|
|
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 UPPR ARM PROCEDURE
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 01730
|
| Hospital Charge Code |
3701730
|
|
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 UPPR ARM PROCEDURE
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 01730
|
| Hospital Charge Code |
3701730
|
|
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 VAGINAL PROCEDURES
|
Facility
|
IP
|
$753.00
|
|
|
Service Code
|
CPT 00940
|
| Hospital Charge Code |
3700940
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$205.57 |
| Max. Negotiated Rate |
$715.35 |
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna Commercial |
$640.05
|
| Rate for Payer: First Health Commercial |
$677.70
|
| Rate for Payer: First Health Workers Compensation |
$290.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$677.70
|
| Rate for Payer: GEHA Commercial |
$527.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$677.70
|
| Rate for Payer: Multiplan All |
$685.23
|
| Rate for Payer: OMNI Networks Commercial |
$527.10
|
| Rate for Payer: One Health Plan PPO/POS |
$677.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$715.35
|
| Rate for Payer: Three Rivers Provider Network All |
$564.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$700.29
|
| Rate for Payer: Zelis Auto |
$301.20
|
| Rate for Payer: Zelis Worker's Compensation |
$205.57
|
|
|
ANESTH VAGINAL PROCEDURES
|
Facility
|
OP
|
$753.00
|
|
|
Service Code
|
CPT 00940
|
| Hospital Charge Code |
3700940
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$715.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna Commercial |
$640.05
|
| Rate for Payer: First Health Commercial |
$677.70
|
| Rate for Payer: First Health Workers Compensation |
$290.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$677.70
|
| Rate for Payer: GEHA Commercial |
$602.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$677.70
|
| Rate for Payer: Humana ChoiceCare |
$195.78
|
| Rate for Payer: Multiplan All |
$685.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$451.80
|
| Rate for Payer: OMNI Networks Commercial |
$527.10
|
| Rate for Payer: One Health Plan PPO/POS |
$677.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$715.35
|
| Rate for Payer: Three Rivers Provider Network All |
$564.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$662.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$700.29
|
| Rate for Payer: Zelis Auto |
$301.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$376.50
|
| Rate for Payer: Zelis Worker's Compensation |
$205.57
|
|
|
ANESTH VASCULAR ACCESS
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00532
|
| Hospital Charge Code |
3700532
|
|
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 VASCULAR ACCESS
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00532
|
| Hospital Charge Code |
3700532
|
|
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 VASECTOMY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00921
|
| Hospital Charge Code |
3700921
|
|
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 VASECTOMY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00921
|
| Hospital Charge Code |
3700921
|
|
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 TUR BLADD TUMOR
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 00912
|
| Hospital Charge Code |
3700912
|
|
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
|
|
|
ANES TUR BLADD TUMOR
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 00912
|
| Hospital Charge Code |
3700912
|
|
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
|
|
|
ANES TYMPANOTOMY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 00126
|
| Hospital Charge Code |
3700126
|
|
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 TYMPANOTOMY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 00126
|
| Hospital Charge Code |
3700126
|
|
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
|
|
|
angiotensin converti enzyme REF010116
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
2299082
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$244.15 |
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$218.45
|
| Rate for Payer: First Health Commercial |
$231.30
|
| Rate for Payer: First Health Workers Compensation |
$25.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$231.30
|
| Rate for Payer: GEHA Commercial |
$179.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$231.30
|
| Rate for Payer: Multiplan All |
$233.87
|
| Rate for Payer: OMNI Networks Commercial |
$179.90
|
| Rate for Payer: One Health Plan PPO/POS |
$231.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$244.15
|
| Rate for Payer: Three Rivers Provider Network All |
$192.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.01
|
| Rate for Payer: Zelis Auto |
$102.80
|
| Rate for Payer: Zelis Worker's Compensation |
$18.19
|
|
|
angiotensin converti enzyme REF010116
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
2299082
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$244.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$154.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$20.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.60
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$218.45
|
| Rate for Payer: First Health Commercial |
$231.30
|
| Rate for Payer: First Health Workers Compensation |
$25.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$231.30
|
| Rate for Payer: GEHA Commercial |
$205.60
|
| Rate for Payer: GEHA Medicare |
$14.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$231.30
|
| Rate for Payer: Humana ChoiceCare |
$16.06
|
| Rate for Payer: Humana Medicare Advantage |
$14.60
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$24.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.60
|
| Rate for Payer: Multiplan All |
$233.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.82
|
| Rate for Payer: OMNI Networks Commercial |
$179.90
|
| Rate for Payer: One Health Plan PPO/POS |
$231.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$244.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.31
|
| Rate for Payer: United Healthcare Commercial |
$218.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.60
|
| Rate for Payer: Zelis Auto |
$102.80
|
| Rate for Payer: Zelis Medicare |
$12.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.52
|
| Rate for Payer: Zelis Worker's Compensation |
$18.19
|
|
|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,134.00
|
|
|
Service Code
|
CPT 29899
|
| Hospital Charge Code |
6129899
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$582.58 |
| Max. Negotiated Rate |
$2,027.30 |
| Rate for Payer: Cash Price |
$1,280.40
|
| Rate for Payer: Cigna Commercial |
$1,813.90
|
| Rate for Payer: First Health Commercial |
$1,920.60
|
| Rate for Payer: First Health Workers Compensation |
$823.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,920.60
|
| Rate for Payer: GEHA Commercial |
$1,493.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,920.60
|
| Rate for Payer: Multiplan All |
$1,941.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,493.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,920.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,027.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,600.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,984.62
|
| Rate for Payer: Zelis Auto |
$853.60
|
| Rate for Payer: Zelis Worker's Compensation |
$582.58
|
|
|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,134.00
|
|
|
Service Code
|
CPT 29899
|
| Hospital Charge Code |
6129899
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$582.58 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,280.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,280.40
|
| Rate for Payer: Cash Price |
$1,280.40
|
| Rate for Payer: Cigna Commercial |
$1,813.90
|
| Rate for Payer: First Health Commercial |
$1,920.60
|
| Rate for Payer: First Health Workers Compensation |
$823.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,920.60
|
| Rate for Payer: GEHA Commercial |
$1,707.20
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,920.60
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,941.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,493.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,920.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,027.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,600.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,984.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$853.60
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$582.58
|
|
|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT 29897
|
| Hospital Charge Code |
6129897
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$283.37 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: First Health Workers Compensation |
$400.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Worker's Compensation |
$283.37
|
|
