|
IMPLT CAP END TI +5MM
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.20 |
| Max. Negotiated Rate |
$843.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$710.40
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cigna Commercial |
$754.80
|
| Rate for Payer: First Health Commercial |
$799.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$799.20
|
| Rate for Payer: GEHA Commercial |
$621.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$799.20
|
| Rate for Payer: Multiplan All |
$808.08
|
| Rate for Payer: OMNI Networks Commercial |
$621.60
|
| Rate for Payer: One Health Plan PPO/POS |
$799.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$843.60
|
| Rate for Payer: Three Rivers Provider Network All |
$666.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$825.84
|
| Rate for Payer: Zelis Auto |
$355.20
|
|
|
IMPLT CAP END TI +5MM
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$843.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cigna Commercial |
$754.80
|
| Rate for Payer: First Health Commercial |
$799.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$799.20
|
| Rate for Payer: GEHA Commercial |
$710.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$799.20
|
| Rate for Payer: Humana ChoiceCare |
$230.88
|
| Rate for Payer: Multiplan All |
$808.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$532.80
|
| Rate for Payer: OMNI Networks Commercial |
$621.60
|
| Rate for Payer: One Health Plan PPO/POS |
$799.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$843.60
|
| Rate for Payer: Three Rivers Provider Network All |
$666.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$781.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$222.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$825.84
|
| Rate for Payer: Zelis Auto |
$355.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$444.00
|
|
|
IMPLT CATH 10.2 DRAINAGE DAWSON
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$497.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$445.40
|
| Rate for Payer: First Health Commercial |
$471.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$471.60
|
| Rate for Payer: GEHA Commercial |
$419.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$471.60
|
| Rate for Payer: Humana ChoiceCare |
$136.24
|
| Rate for Payer: Multiplan All |
$476.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$314.40
|
| Rate for Payer: OMNI Networks Commercial |
$366.80
|
| Rate for Payer: One Health Plan PPO/POS |
$471.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$497.80
|
| Rate for Payer: Three Rivers Provider Network All |
$393.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$461.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$131.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$487.32
|
| Rate for Payer: Zelis Auto |
$209.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$262.00
|
|
|
IMPLT CATH 10.2 DRAINAGE DAWSON
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$497.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$419.20
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$445.40
|
| Rate for Payer: First Health Commercial |
$471.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$471.60
|
| Rate for Payer: GEHA Commercial |
$366.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$471.60
|
| Rate for Payer: Multiplan All |
$476.84
|
| Rate for Payer: OMNI Networks Commercial |
$366.80
|
| Rate for Payer: One Health Plan PPO/POS |
$471.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$497.80
|
| Rate for Payer: Three Rivers Provider Network All |
$393.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$487.32
|
| Rate for Payer: Zelis Auto |
$209.60
|
|
|
IMPLT CATH 10.2 DRAIN RING BILI DUCT
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$389.60
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$340.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: Zelis Auto |
$194.80
|
|
|
IMPLT CATH 10.2 DRAIN RING BILI DUCT
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.75 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$389.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Humana ChoiceCare |
$126.62
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$292.20
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$428.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: Zelis Auto |
$194.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$243.50
|
|
|
IMPLT CATH 12.0 DRAIN RING BILI DUCT
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$483.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Humana ChoiceCare |
$157.04
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$362.40
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$531.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.00
|
|
|
IMPLT CATH 12.0 DRAIN RING BILI DUCT
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.60 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$483.20
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$422.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
|
|
IMPLT CATH 5FR CONE TIP
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
7003381
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.93 |
| Max. Negotiated Rate |
$90.25 |
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: First Health Workers Compensation |
$36.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.50
|
| Rate for Payer: GEHA Commercial |
$66.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.50
|
| Rate for Payer: Multiplan All |
$86.45
|
| Rate for Payer: OMNI Networks Commercial |
$66.50
|
| Rate for Payer: One Health Plan PPO/POS |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.25
|
| Rate for Payer: Three Rivers Provider Network All |
$71.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.35
|
| Rate for Payer: Zelis Auto |
$38.00
|
| Rate for Payer: Zelis Worker's Compensation |
$25.93
|
|
|
IMPLT CATH 5FR CONE TIP
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
7003381
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$90.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: First Health Workers Compensation |
$36.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$85.50
|
| Rate for Payer: GEHA Commercial |
$76.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$85.50
|
| Rate for Payer: Humana ChoiceCare |
$24.70
|
| Rate for Payer: Multiplan All |
$86.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$57.00
|
| Rate for Payer: OMNI Networks Commercial |
$66.50
|
| Rate for Payer: One Health Plan PPO/POS |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$90.25
|
| Rate for Payer: Three Rivers Provider Network All |
$71.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$88.35
|
| Rate for Payer: Zelis Auto |
$38.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$47.50
|
| Rate for Payer: Zelis Worker's Compensation |
$25.93
|
|
|
IMPLT CATH 5FR OPEN END
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
7003380
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: First Health Commercial |
$81.90
|
| Rate for Payer: First Health Workers Compensation |
$35.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.90
|
| Rate for Payer: GEHA Commercial |
$63.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.90
|
| Rate for Payer: Multiplan All |
$82.81
|
| Rate for Payer: OMNI Networks Commercial |
$63.70
|
| Rate for Payer: One Health Plan PPO/POS |
$81.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.45
|
| Rate for Payer: Three Rivers Provider Network All |
$68.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.63
|
| Rate for Payer: Zelis Auto |
$36.40
|
| Rate for Payer: Zelis Worker's Compensation |
$24.84
|
|
|
IMPLT CATH 5FR OPEN END
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
7003380
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: First Health Commercial |
$81.90
|
| Rate for Payer: First Health Workers Compensation |
$35.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.90
|
| Rate for Payer: GEHA Commercial |
$72.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.90
|
| Rate for Payer: Humana ChoiceCare |
$23.66
|
| Rate for Payer: Multiplan All |
$82.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$54.60
|
| Rate for Payer: OMNI Networks Commercial |
$63.70
|
| Rate for Payer: One Health Plan PPO/POS |
$81.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.45
|
| Rate for Payer: Three Rivers Provider Network All |
$68.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$80.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.63
|
| Rate for Payer: Zelis Auto |
$36.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$45.50
|
| Rate for Payer: Zelis Worker's Compensation |
$24.84
|
|
|
IMPLT CATH 5FR ROYAL FLUSH NYLON 5EA
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
7001646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.40
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$194.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
|
|
IMPLT CATH 5FR ROYAL FLUSH NYLON 5EA
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
7001646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$222.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Humana ChoiceCare |
$72.28
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$166.80
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$244.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$139.00
|
|
|
IMPLT CATH 6FR DRAINAGE DAWSON
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$497.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$419.20
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$445.40
|
| Rate for Payer: First Health Commercial |
$471.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$471.60
|
| Rate for Payer: GEHA Commercial |
$366.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$471.60
|
| Rate for Payer: Multiplan All |
$476.84
|
| Rate for Payer: OMNI Networks Commercial |
$366.80
|
| Rate for Payer: One Health Plan PPO/POS |
$471.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$497.80
|
| Rate for Payer: Three Rivers Provider Network All |
$393.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$487.32
|
| Rate for Payer: Zelis Auto |
$209.60
|
|
|
IMPLT CATH 6FR DRAINAGE DAWSON
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$497.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$445.40
|
| Rate for Payer: First Health Commercial |
$471.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$471.60
|
| Rate for Payer: GEHA Commercial |
$419.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$471.60
|
| Rate for Payer: Humana ChoiceCare |
$136.24
|
| Rate for Payer: Multiplan All |
$476.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$314.40
|
| Rate for Payer: OMNI Networks Commercial |
$366.80
|
| Rate for Payer: One Health Plan PPO/POS |
$471.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$497.80
|
| Rate for Payer: Three Rivers Provider Network All |
$393.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$461.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$131.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$487.32
|
| Rate for Payer: Zelis Auto |
$209.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$262.00
|
|
|
IMPLT CATH 8.5 DRAIN RING BILI DUCT
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.60 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$483.20
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$422.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
|
|
IMPLT CATH 8.5 DRAIN RING BILI DUCT
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$483.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Humana ChoiceCare |
$157.04
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$362.40
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$531.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.00
|
|
|
IMPLT CATH 8.5FR BILIARY DRAIN
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.80 |
| Max. Negotiated Rate |
$590.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$497.60
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$528.70
|
| Rate for Payer: First Health Commercial |
$559.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$559.80
|
| Rate for Payer: GEHA Commercial |
$435.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$559.80
|
| Rate for Payer: Multiplan All |
$566.02
|
| Rate for Payer: OMNI Networks Commercial |
$435.40
|
| Rate for Payer: One Health Plan PPO/POS |
$559.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$590.90
|
| Rate for Payer: Three Rivers Provider Network All |
$466.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$578.46
|
| Rate for Payer: Zelis Auto |
$248.80
|
|
|
IMPLT CATH 8.5FR BILIARY DRAIN
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.50 |
| Max. Negotiated Rate |
$590.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.20
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$528.70
|
| Rate for Payer: First Health Commercial |
$559.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$559.80
|
| Rate for Payer: GEHA Commercial |
$497.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$559.80
|
| Rate for Payer: Humana ChoiceCare |
$161.72
|
| Rate for Payer: Multiplan All |
$566.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$373.20
|
| Rate for Payer: OMNI Networks Commercial |
$435.40
|
| Rate for Payer: One Health Plan PPO/POS |
$559.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$590.90
|
| Rate for Payer: Three Rivers Provider Network All |
$466.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$547.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$155.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$578.46
|
| Rate for Payer: Zelis Auto |
$248.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$311.00
|
|
|
IMPLT CATH 8.5FR DRAINAGE DAWSON
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.75 |
| Max. Negotiated Rate |
$477.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$427.55
|
| Rate for Payer: First Health Commercial |
$452.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$452.70
|
| Rate for Payer: GEHA Commercial |
$402.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$452.70
|
| Rate for Payer: Humana ChoiceCare |
$130.78
|
| Rate for Payer: Multiplan All |
$457.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$301.80
|
| Rate for Payer: OMNI Networks Commercial |
$352.10
|
| Rate for Payer: One Health Plan PPO/POS |
$452.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$477.85
|
| Rate for Payer: Three Rivers Provider Network All |
$377.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$442.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$467.79
|
| Rate for Payer: Zelis Auto |
$201.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$251.50
|
|
|
IMPLT CATH 8.5FR DRAINAGE DAWSON
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7001678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$477.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$402.40
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$427.55
|
| Rate for Payer: First Health Commercial |
$452.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$452.70
|
| Rate for Payer: GEHA Commercial |
$352.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$452.70
|
| Rate for Payer: Multiplan All |
$457.73
|
| Rate for Payer: OMNI Networks Commercial |
$352.10
|
| Rate for Payer: One Health Plan PPO/POS |
$452.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$477.85
|
| Rate for Payer: Three Rivers Provider Network All |
$377.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$467.79
|
| Rate for Payer: Zelis Auto |
$201.20
|
|
|
IMPLT CATH ARTERIAL EMBOLECTOMY 4FR
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
7001687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$221.85
|
| Rate for Payer: First Health Commercial |
$234.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.90
|
| Rate for Payer: GEHA Commercial |
$208.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.90
|
| Rate for Payer: Humana ChoiceCare |
$67.86
|
| Rate for Payer: Multiplan All |
$237.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$156.60
|
| Rate for Payer: OMNI Networks Commercial |
$182.70
|
| Rate for Payer: One Health Plan PPO/POS |
$234.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.95
|
| Rate for Payer: Three Rivers Provider Network All |
$195.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$242.73
|
| Rate for Payer: Zelis Auto |
$104.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$130.50
|
|
|
IMPLT CATH ARTERIAL EMBOLECTOMY 4FR
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
7001687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$208.80
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$221.85
|
| Rate for Payer: First Health Commercial |
$234.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.90
|
| Rate for Payer: GEHA Commercial |
$182.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.90
|
| Rate for Payer: Multiplan All |
$237.51
|
| Rate for Payer: OMNI Networks Commercial |
$182.70
|
| Rate for Payer: One Health Plan PPO/POS |
$234.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.95
|
| Rate for Payer: Three Rivers Provider Network All |
$195.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$242.73
|
| Rate for Payer: Zelis Auto |
$104.40
|
|
|
IMPLT CATH CHEST TUBE 8 FR
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
70006377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$31.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
|
