|
IMPLT BALLOON DILATOR ACHALASIA 30MM
|
Facility
|
IP
|
$2,643.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,057.20 |
| Max. Negotiated Rate |
$2,510.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,114.40
|
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Cigna Commercial |
$2,246.55
|
| Rate for Payer: First Health Commercial |
$2,378.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,378.70
|
| Rate for Payer: GEHA Commercial |
$1,850.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,378.70
|
| Rate for Payer: Multiplan All |
$2,405.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,378.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,510.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,982.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,457.99
|
| Rate for Payer: Zelis Auto |
$1,057.20
|
|
|
IMPLT BALLOON DILATOR ACHALASIA 35MM
|
Facility
|
IP
|
$2,643.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,057.20 |
| Max. Negotiated Rate |
$2,510.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,114.40
|
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Cigna Commercial |
$2,246.55
|
| Rate for Payer: First Health Commercial |
$2,378.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,378.70
|
| Rate for Payer: GEHA Commercial |
$1,850.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,378.70
|
| Rate for Payer: Multiplan All |
$2,405.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,378.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,510.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,982.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,457.99
|
| Rate for Payer: Zelis Auto |
$1,057.20
|
|
|
IMPLT BALLOON DILATOR ACHALASIA 35MM
|
Facility
|
OP
|
$2,643.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.75 |
| Max. Negotiated Rate |
$2,510.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,585.80
|
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Cigna Commercial |
$2,246.55
|
| Rate for Payer: First Health Commercial |
$2,378.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,378.70
|
| Rate for Payer: GEHA Commercial |
$2,114.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,378.70
|
| Rate for Payer: Humana ChoiceCare |
$687.18
|
| Rate for Payer: Multiplan All |
$2,405.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,585.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,378.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,510.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,982.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,325.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$660.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,457.99
|
| Rate for Payer: Zelis Auto |
$1,057.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,321.50
|
|
|
IMPLT BALLOON GASTRIC ORBERA
|
Facility
|
IP
|
$1,015.00
|
|
| Hospital Charge Code |
7006156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.00 |
| Max. Negotiated Rate |
$964.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$812.00
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cigna Commercial |
$862.75
|
| Rate for Payer: First Health Commercial |
$913.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$913.50
|
| Rate for Payer: GEHA Commercial |
$710.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$913.50
|
| Rate for Payer: Multiplan All |
$923.65
|
| Rate for Payer: OMNI Networks Commercial |
$710.50
|
| Rate for Payer: One Health Plan PPO/POS |
$913.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$964.25
|
| Rate for Payer: Three Rivers Provider Network All |
$761.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.95
|
| Rate for Payer: Zelis Auto |
$406.00
|
|
|
IMPLT BALLOON GASTRIC ORBERA
|
Facility
|
OP
|
$1,015.00
|
|
| Hospital Charge Code |
7006156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.75 |
| Max. Negotiated Rate |
$964.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$609.00
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cigna Commercial |
$862.75
|
| Rate for Payer: First Health Commercial |
$913.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$913.50
|
| Rate for Payer: GEHA Commercial |
$812.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$913.50
|
| Rate for Payer: Humana ChoiceCare |
$263.90
|
| Rate for Payer: Multiplan All |
$923.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$609.00
|
| Rate for Payer: OMNI Networks Commercial |
$710.50
|
| Rate for Payer: One Health Plan PPO/POS |
$913.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$964.25
|
| Rate for Payer: Three Rivers Provider Network All |
$761.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$893.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$253.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.95
|
| Rate for Payer: Zelis Auto |
$406.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$507.50
|
|
|
IMPLT BALLOON PRESSURE REGULATING
|
Facility
|
IP
|
$8,639.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7002475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,455.60 |
| Max. Negotiated Rate |
$8,207.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,911.20
|
| Rate for Payer: Cash Price |
$5,183.40
|
| Rate for Payer: Cash Price |
$5,183.40
|
| Rate for Payer: Cigna Commercial |
$7,343.15
|
| Rate for Payer: First Health Commercial |
$7,775.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,775.10
|
| Rate for Payer: GEHA Commercial |
$6,047.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,775.10
|
| Rate for Payer: Multiplan All |
$7,861.49
|
| Rate for Payer: OMNI Networks Commercial |
$6,047.30
|
| Rate for Payer: One Health Plan PPO/POS |
$7,775.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,207.05
|
| Rate for Payer: Three Rivers Provider Network All |
$6,479.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,034.27
|
| Rate for Payer: Zelis Auto |
$3,455.60
|
|
|
IMPLT BALLOON PRESSURE REGULATING
|
Facility
|
OP
|
$8,639.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7002475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,159.75 |
| Max. Negotiated Rate |
$8,207.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,183.40
|
| Rate for Payer: Cash Price |
$5,183.40
|
| Rate for Payer: Cash Price |
$5,183.40
|
| Rate for Payer: Cigna Commercial |
$7,343.15
|
| Rate for Payer: First Health Commercial |
$7,775.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,775.10
|
| Rate for Payer: GEHA Commercial |
$6,911.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,775.10
|
| Rate for Payer: Humana ChoiceCare |
$2,246.14
|
| Rate for Payer: Multiplan All |
$7,861.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,183.40
|
| Rate for Payer: OMNI Networks Commercial |
$6,047.30
|
| Rate for Payer: One Health Plan PPO/POS |
$7,775.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,207.05
|
| Rate for Payer: Three Rivers Provider Network All |
$6,479.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,602.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,034.27
|
| Rate for Payer: Zelis Auto |
$3,455.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,319.50
|
|
|
IMPLT BALLOON SINUPLASTY FRONTAL
|
Facility
|
OP
|
$1,614.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.50 |
| Max. Negotiated Rate |
$1,533.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$968.40
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cigna Commercial |
$1,371.90
|
| Rate for Payer: First Health Commercial |
$1,452.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,452.60
|
| Rate for Payer: GEHA Commercial |
$1,291.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,452.60
|
| Rate for Payer: Humana ChoiceCare |
$419.64
|
| Rate for Payer: Multiplan All |
$1,468.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$968.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,129.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,452.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,533.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,210.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,420.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$403.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,501.02
|
| Rate for Payer: Zelis Auto |
$645.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$807.00
|
|
|
IMPLT BALLOON SINUPLASTY FRONTAL
|
Facility
|
IP
|
$1,614.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.60 |
| Max. Negotiated Rate |
$1,533.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,291.20
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cigna Commercial |
$1,371.90
|
| Rate for Payer: First Health Commercial |
$1,452.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,452.60
|
| Rate for Payer: GEHA Commercial |
$1,129.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,452.60
|
| Rate for Payer: Multiplan All |
$1,468.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,129.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,452.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,533.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,210.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,501.02
|
| Rate for Payer: Zelis Auto |
$645.60
|
|
|
IMPLT BALLOON SINUPLASTY MAXILLARY
|
Facility
|
OP
|
$5,862.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,465.50 |
| Max. Negotiated Rate |
$5,568.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,517.20
|
| Rate for Payer: Cash Price |
$3,517.20
|
| Rate for Payer: Cash Price |
$3,517.20
|
| Rate for Payer: Cigna Commercial |
$4,982.70
|
| Rate for Payer: First Health Commercial |
$5,275.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,275.80
|
| Rate for Payer: GEHA Commercial |
$4,689.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,275.80
|
| Rate for Payer: Humana ChoiceCare |
$1,524.12
|
| Rate for Payer: Multiplan All |
$5,334.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,517.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,103.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,275.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,568.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,396.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,158.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,465.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,451.66
|
| Rate for Payer: Zelis Auto |
$2,344.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,931.00
|
|
|
IMPLT BALLOON SINUPLASTY MAXILLARY
|
Facility
|
IP
|
$5,862.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,344.80 |
| Max. Negotiated Rate |
$5,568.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,689.60
|
| Rate for Payer: Cash Price |
$3,517.20
|
| Rate for Payer: Cash Price |
$3,517.20
|
| Rate for Payer: Cigna Commercial |
$4,982.70
|
| Rate for Payer: First Health Commercial |
$5,275.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,275.80
|
| Rate for Payer: GEHA Commercial |
$4,103.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,275.80
|
| Rate for Payer: Multiplan All |
$5,334.42
|
| Rate for Payer: OMNI Networks Commercial |
$4,103.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,275.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,568.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,396.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,451.66
|
| Rate for Payer: Zelis Auto |
$2,344.80
|
|
|
IMPLT BAR LCK TIBIAL MODULAR SYSTEM
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.80 |
| Max. Negotiated Rate |
$842.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$709.60
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$753.95
|
| Rate for Payer: First Health Commercial |
$798.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.30
|
| Rate for Payer: GEHA Commercial |
$620.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.30
|
| Rate for Payer: Multiplan All |
$807.17
|
| Rate for Payer: OMNI Networks Commercial |
$620.90
|
| Rate for Payer: One Health Plan PPO/POS |
$798.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.65
|
| Rate for Payer: Three Rivers Provider Network All |
$665.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$824.91
|
| Rate for Payer: Zelis Auto |
$354.80
|
|
|
IMPLT BAR LCK TIBIAL MODULAR SYSTEM
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.75 |
| Max. Negotiated Rate |
$842.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$753.95
|
| Rate for Payer: First Health Commercial |
$798.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.30
|
| Rate for Payer: GEHA Commercial |
$709.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.30
|
| Rate for Payer: Humana ChoiceCare |
$230.62
|
| Rate for Payer: Multiplan All |
$807.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$532.20
|
| Rate for Payer: OMNI Networks Commercial |
$620.90
|
| Rate for Payer: One Health Plan PPO/POS |
$798.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.65
|
| Rate for Payer: Three Rivers Provider Network All |
$665.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$780.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$221.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$824.91
|
| Rate for Payer: Zelis Auto |
$354.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$443.50
|
|
|
IMPLT BARR 360RFA CATHETER 25MM
|
Facility
|
IP
|
$6,181.00
|
|
|
Service Code
|
CPT C1888
|
| Hospital Charge Code |
7002401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,472.40 |
| Max. Negotiated Rate |
$5,871.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,944.80
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cigna Commercial |
$5,253.85
|
| Rate for Payer: First Health Commercial |
$5,562.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,562.90
|
| Rate for Payer: GEHA Commercial |
$4,326.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,562.90
|
| Rate for Payer: Multiplan All |
$5,624.71
|
| Rate for Payer: OMNI Networks Commercial |
$4,326.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,562.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,871.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,635.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,748.33
|
| Rate for Payer: Zelis Auto |
$2,472.40
|
|
|
IMPLT BARR 360RFA CATHETER 25MM
|
Facility
|
OP
|
$6,181.00
|
|
|
Service Code
|
CPT C1888
|
| Hospital Charge Code |
7002401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.25 |
| Max. Negotiated Rate |
$5,871.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cigna Commercial |
$5,253.85
|
| Rate for Payer: First Health Commercial |
$5,562.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,562.90
|
| Rate for Payer: GEHA Commercial |
$4,944.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,562.90
|
| Rate for Payer: Humana ChoiceCare |
$1,607.06
|
| Rate for Payer: Multiplan All |
$5,624.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,708.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,326.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,562.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,871.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,635.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,439.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,545.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,748.33
|
| Rate for Payer: Zelis Auto |
$2,472.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,090.50
|
|
|
IMPLT BARRX 360RFA CATHETER 18MM
|
Facility
|
IP
|
$6,181.00
|
|
|
Service Code
|
CPT C1888
|
| Hospital Charge Code |
7002400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,472.40 |
| Max. Negotiated Rate |
$5,871.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,944.80
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cigna Commercial |
$5,253.85
|
| Rate for Payer: First Health Commercial |
$5,562.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,562.90
|
| Rate for Payer: GEHA Commercial |
$4,326.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,562.90
|
| Rate for Payer: Multiplan All |
$5,624.71
|
| Rate for Payer: OMNI Networks Commercial |
$4,326.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,562.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,871.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,635.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,748.33
|
| Rate for Payer: Zelis Auto |
$2,472.40
|
|
|
IMPLT BARRX 360RFA CATHETER 18MM
|
Facility
|
OP
|
$6,181.00
|
|
|
Service Code
|
CPT C1888
|
| Hospital Charge Code |
7002400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.25 |
| Max. Negotiated Rate |
$5,871.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cigna Commercial |
$5,253.85
|
| Rate for Payer: First Health Commercial |
$5,562.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,562.90
|
| Rate for Payer: GEHA Commercial |
$4,944.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,562.90
|
| Rate for Payer: Humana ChoiceCare |
$1,607.06
|
| Rate for Payer: Multiplan All |
$5,624.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,708.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,326.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,562.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,871.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,635.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,439.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,545.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,748.33
|
| Rate for Payer: Zelis Auto |
$2,472.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,090.50
|
|
|
IMPLT BARRX RFA ENDO GUIDEWIRE .038
|
Facility
|
IP
|
$914.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.60 |
| Max. Negotiated Rate |
$868.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$731.20
|
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cigna Commercial |
$776.90
|
| Rate for Payer: First Health Commercial |
$822.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.60
|
| Rate for Payer: GEHA Commercial |
$639.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.60
|
| Rate for Payer: Multiplan All |
$831.74
|
| Rate for Payer: OMNI Networks Commercial |
$639.80
|
| Rate for Payer: One Health Plan PPO/POS |
$822.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$868.30
|
| Rate for Payer: Three Rivers Provider Network All |
$685.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.02
|
| Rate for Payer: Zelis Auto |
$365.60
|
|
|
IMPLT BARRX RFA ENDO GUIDEWIRE .038
|
Facility
|
OP
|
$914.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.50 |
| Max. Negotiated Rate |
$868.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.40
|
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cigna Commercial |
$776.90
|
| Rate for Payer: First Health Commercial |
$822.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.60
|
| Rate for Payer: GEHA Commercial |
$731.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.60
|
| Rate for Payer: Humana ChoiceCare |
$237.64
|
| Rate for Payer: Multiplan All |
$831.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$548.40
|
| Rate for Payer: OMNI Networks Commercial |
$639.80
|
| Rate for Payer: One Health Plan PPO/POS |
$822.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$868.30
|
| Rate for Payer: Three Rivers Provider Network All |
$685.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$804.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.02
|
| Rate for Payer: Zelis Auto |
$365.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.00
|
|
|
IMPLT BASE GLENOID HYBRID 4MM
|
Facility
|
OP
|
$6,656.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,664.00 |
| Max. Negotiated Rate |
$6,323.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,993.60
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Cigna Commercial |
$5,657.60
|
| Rate for Payer: First Health Commercial |
$5,990.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,990.40
|
| Rate for Payer: GEHA Commercial |
$5,324.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,990.40
|
| Rate for Payer: Humana ChoiceCare |
$1,730.56
|
| Rate for Payer: Multiplan All |
$6,056.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,993.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,659.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,990.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,323.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,992.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,857.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,664.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,190.08
|
| Rate for Payer: Zelis Auto |
$2,662.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,328.00
|
|
|
IMPLT BASE GLENOID HYBRID 4MM
|
Facility
|
IP
|
$6,656.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,662.40 |
| Max. Negotiated Rate |
$6,323.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,324.80
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Cigna Commercial |
$5,657.60
|
| Rate for Payer: First Health Commercial |
$5,990.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,990.40
|
| Rate for Payer: GEHA Commercial |
$4,659.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,990.40
|
| Rate for Payer: Multiplan All |
$6,056.96
|
| Rate for Payer: OMNI Networks Commercial |
$4,659.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,990.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,323.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,992.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,190.08
|
| Rate for Payer: Zelis Auto |
$2,662.40
|
|
|
IMPLT BASEPLATE 25MM POST+2MM OFFSET
|
Facility
|
OP
|
$10,505.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,626.25 |
| Max. Negotiated Rate |
$9,979.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,303.00
|
| Rate for Payer: Cash Price |
$6,303.00
|
| Rate for Payer: Cash Price |
$6,303.00
|
| Rate for Payer: Cigna Commercial |
$8,929.25
|
| Rate for Payer: First Health Commercial |
$9,454.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,454.50
|
| Rate for Payer: GEHA Commercial |
$8,404.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,454.50
|
| Rate for Payer: Humana ChoiceCare |
$2,731.30
|
| Rate for Payer: Multiplan All |
$9,559.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,303.00
|
| Rate for Payer: OMNI Networks Commercial |
$7,353.50
|
| Rate for Payer: One Health Plan PPO/POS |
$9,454.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,979.75
|
| Rate for Payer: Three Rivers Provider Network All |
$7,878.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,244.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,626.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,769.65
|
| Rate for Payer: Zelis Auto |
$4,202.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,252.50
|
|
|
IMPLT BASEPLATE 25MM POST+2MM OFFSET
|
Facility
|
IP
|
$10,505.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,202.00 |
| Max. Negotiated Rate |
$9,979.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,404.00
|
| Rate for Payer: Cash Price |
$6,303.00
|
| Rate for Payer: Cash Price |
$6,303.00
|
| Rate for Payer: Cigna Commercial |
$8,929.25
|
| Rate for Payer: First Health Commercial |
$9,454.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,454.50
|
| Rate for Payer: GEHA Commercial |
$7,353.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,454.50
|
| Rate for Payer: Multiplan All |
$9,559.55
|
| Rate for Payer: OMNI Networks Commercial |
$7,353.50
|
| Rate for Payer: One Health Plan PPO/POS |
$9,454.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,979.75
|
| Rate for Payer: Three Rivers Provider Network All |
$7,878.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,769.65
|
| Rate for Payer: Zelis Auto |
$4,202.00
|
|
|
IMPLT BASEPLATE GLENOID DIAMETER 28MM
|
Facility
|
IP
|
$5,745.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.00 |
| Max. Negotiated Rate |
$5,457.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,596.00
|
| Rate for Payer: Cash Price |
$3,447.00
|
| Rate for Payer: Cash Price |
$3,447.00
|
| Rate for Payer: Cigna Commercial |
$4,883.25
|
| Rate for Payer: First Health Commercial |
$5,170.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,170.50
|
| Rate for Payer: GEHA Commercial |
$4,021.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,170.50
|
| Rate for Payer: Multiplan All |
$5,227.95
|
| Rate for Payer: OMNI Networks Commercial |
$4,021.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,170.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,457.75
|
| Rate for Payer: Three Rivers Provider Network All |
$4,308.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,342.85
|
| Rate for Payer: Zelis Auto |
$2,298.00
|
|
|
IMPLT BASEPLATE GLENOID DIAMETER 28MM
|
Facility
|
OP
|
$5,745.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.25 |
| Max. Negotiated Rate |
$5,457.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,447.00
|
| Rate for Payer: Cash Price |
$3,447.00
|
| Rate for Payer: Cash Price |
$3,447.00
|
| Rate for Payer: Cigna Commercial |
$4,883.25
|
| Rate for Payer: First Health Commercial |
$5,170.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,170.50
|
| Rate for Payer: GEHA Commercial |
$4,596.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,170.50
|
| Rate for Payer: Humana ChoiceCare |
$1,493.70
|
| Rate for Payer: Multiplan All |
$5,227.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,447.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,021.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,170.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,457.75
|
| Rate for Payer: Three Rivers Provider Network All |
$4,308.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,055.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,436.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,342.85
|
| Rate for Payer: Zelis Auto |
$2,298.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,872.50
|
|
