|
IMPLT CATH FOGARTY EMBOLECTOMY 5FR
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
7001689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$79.30
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.00
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$268.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.50
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
IMPLT CATH FOGARTY EMBOLECTOMY 5FR
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
7001689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.27 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
IMPLT CATH GROSHONG 9.5FR SURECUFF
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
7001682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$1,197.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$756.00
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cigna Commercial |
$1,071.00
|
| Rate for Payer: First Health Commercial |
$1,134.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,134.00
|
| Rate for Payer: GEHA Commercial |
$1,008.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,134.00
|
| Rate for Payer: Humana ChoiceCare |
$327.60
|
| Rate for Payer: Multiplan All |
$1,146.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$756.00
|
| Rate for Payer: OMNI Networks Commercial |
$882.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,134.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,197.00
|
| Rate for Payer: Three Rivers Provider Network All |
$945.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,108.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$315.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,171.80
|
| Rate for Payer: Zelis Auto |
$504.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$630.00
|
|
|
IMPLT CATH GROSHONG 9.5FR SURECUFF
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
7001682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,197.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,008.00
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cigna Commercial |
$1,071.00
|
| Rate for Payer: First Health Commercial |
$1,134.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,134.00
|
| Rate for Payer: GEHA Commercial |
$882.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,134.00
|
| Rate for Payer: Multiplan All |
$1,146.60
|
| Rate for Payer: OMNI Networks Commercial |
$882.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,134.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,197.00
|
| Rate for Payer: Three Rivers Provider Network All |
$945.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,171.80
|
| Rate for Payer: Zelis Auto |
$504.00
|
|
|
IMPLT CATH HI-FLO 35X100 ROYAL FLUSH
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
7001647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$66.04
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$152.40
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$127.00
|
|
|
IMPLT CATH HI-FLO 35X100 ROYAL FLUSH
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
7001647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$203.20
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
|
|
IMPLT CATH HI-FLO 38X100 ROYAL FLUS
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
7001648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.20
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$118.15
|
| Rate for Payer: First Health Commercial |
$125.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$125.10
|
| Rate for Payer: GEHA Commercial |
$97.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$125.10
|
| Rate for Payer: Multiplan All |
$126.49
|
| Rate for Payer: OMNI Networks Commercial |
$97.30
|
| Rate for Payer: One Health Plan PPO/POS |
$125.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$132.05
|
| Rate for Payer: Three Rivers Provider Network All |
$104.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$129.27
|
| Rate for Payer: Zelis Auto |
$55.60
|
|
|
IMPLT CATH HI-FLO 38X100 ROYAL FLUS
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
7001648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$118.15
|
| Rate for Payer: First Health Commercial |
$125.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$125.10
|
| Rate for Payer: GEHA Commercial |
$111.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$125.10
|
| Rate for Payer: Humana ChoiceCare |
$36.14
|
| Rate for Payer: Multiplan All |
$126.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$83.40
|
| Rate for Payer: OMNI Networks Commercial |
$97.30
|
| Rate for Payer: One Health Plan PPO/POS |
$125.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$132.05
|
| Rate for Payer: Three Rivers Provider Network All |
$104.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$129.27
|
| Rate for Payer: Zelis Auto |
$55.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.50
|
|
|
IMPLT CATH SINGLE LUMEN CVC 9FR
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
7001649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.25 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$250.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Humana ChoiceCare |
$81.38
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$187.80
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$275.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$78.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: Zelis Auto |
$125.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$156.50
|
|
|
IMPLT CATH SINGLE LUMEN CVC 9FR
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
7001649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.20 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$250.40
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$266.05
|
| Rate for Payer: First Health Commercial |
$281.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$281.70
|
| Rate for Payer: GEHA Commercial |
$219.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$281.70
|
| Rate for Payer: Multiplan All |
$284.83
|
| Rate for Payer: OMNI Networks Commercial |
$219.10
|
| Rate for Payer: One Health Plan PPO/POS |
$281.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$297.35
|
| Rate for Payer: Three Rivers Provider Network All |
$234.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$291.09
|
| Rate for Payer: Zelis Auto |
$125.20
|
|
|
IMPLT CATH SUPRAPUBIC 12FR.
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.80
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$133.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: Zelis Auto |
$76.40
|
|
|
IMPLT CATH SUPRAPUBIC 12FR.
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$152.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| Rate for Payer: Humana ChoiceCare |
$49.66
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.60
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: Zelis Auto |
$76.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$95.50
|
|
|
IMPLT CATH SUPRAPUBIC 16FR.
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$152.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| Rate for Payer: Humana ChoiceCare |
$49.66
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.60
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: Zelis Auto |
$76.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$95.50
|
|
|
IMPLT CATH SUPRAPUBIC 16FR.
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.80
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$133.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: Zelis Auto |
$76.40
|
|
|
IMPLT CATH SUPRAPUBIC SANT-20-20-PLV
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$534.65
|
| Rate for Payer: First Health Commercial |
$566.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$566.10
|
| Rate for Payer: GEHA Commercial |
$503.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$566.10
|
| Rate for Payer: Humana ChoiceCare |
$163.54
|
| Rate for Payer: Multiplan All |
$572.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$377.40
|
| Rate for Payer: OMNI Networks Commercial |
$440.30
|
| Rate for Payer: One Health Plan PPO/POS |
$566.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$597.55
|
| Rate for Payer: Three Rivers Provider Network All |
$471.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$553.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$157.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$584.97
|
| Rate for Payer: Zelis Auto |
$251.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$314.50
|
|
|
IMPLT CATH SUPRAPUBIC SANT-20-20-PLV
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.60 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$503.20
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$534.65
|
| Rate for Payer: First Health Commercial |
$566.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$566.10
|
| Rate for Payer: GEHA Commercial |
$440.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$566.10
|
| Rate for Payer: Multiplan All |
$572.39
|
| Rate for Payer: OMNI Networks Commercial |
$440.30
|
| Rate for Payer: One Health Plan PPO/POS |
$566.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$597.55
|
| Rate for Payer: Three Rivers Provider Network All |
$471.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$584.97
|
| Rate for Payer: Zelis Auto |
$251.60
|
|
|
IMPLT CATH SUPRAPUBIC SANT-22-20-PLV
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$534.65
|
| Rate for Payer: First Health Commercial |
$566.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$566.10
|
| Rate for Payer: GEHA Commercial |
$503.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$566.10
|
| Rate for Payer: Humana ChoiceCare |
$163.54
|
| Rate for Payer: Multiplan All |
$572.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$377.40
|
| Rate for Payer: OMNI Networks Commercial |
$440.30
|
| Rate for Payer: One Health Plan PPO/POS |
$566.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$597.55
|
| Rate for Payer: Three Rivers Provider Network All |
$471.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$553.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$157.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$584.97
|
| Rate for Payer: Zelis Auto |
$251.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$314.50
|
|
|
IMPLT CATH SUPRAPUBIC SANT-22-20-PLV
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.60 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$503.20
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$534.65
|
| Rate for Payer: First Health Commercial |
$566.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$566.10
|
| Rate for Payer: GEHA Commercial |
$440.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$566.10
|
| Rate for Payer: Multiplan All |
$572.39
|
| Rate for Payer: OMNI Networks Commercial |
$440.30
|
| Rate for Payer: One Health Plan PPO/POS |
$566.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$597.55
|
| Rate for Payer: Three Rivers Provider Network All |
$471.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$584.97
|
| Rate for Payer: Zelis Auto |
$251.60
|
|
|
IMPLT CATH SUPRAPUBIC SET 10.0
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.40 |
| Max. Negotiated Rate |
$399.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$336.80
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$357.85
|
| Rate for Payer: First Health Commercial |
$378.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.90
|
| Rate for Payer: GEHA Commercial |
$294.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.90
|
| Rate for Payer: Multiplan All |
$383.11
|
| Rate for Payer: OMNI Networks Commercial |
$294.70
|
| Rate for Payer: One Health Plan PPO/POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.95
|
| Rate for Payer: Three Rivers Provider Network All |
$315.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$391.53
|
| Rate for Payer: Zelis Auto |
$168.40
|
|
|
IMPLT CATH SUPRAPUBIC SET 10.0
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.25 |
| Max. Negotiated Rate |
$399.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$357.85
|
| Rate for Payer: First Health Commercial |
$378.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.90
|
| Rate for Payer: GEHA Commercial |
$336.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.90
|
| Rate for Payer: Humana ChoiceCare |
$109.46
|
| Rate for Payer: Multiplan All |
$383.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.60
|
| Rate for Payer: OMNI Networks Commercial |
$294.70
|
| Rate for Payer: One Health Plan PPO/POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.95
|
| Rate for Payer: Three Rivers Provider Network All |
$315.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$370.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$105.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$391.53
|
| Rate for Payer: Zelis Auto |
$168.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$210.50
|
|
|
IMPLT CATH SUPRAPUBIC SET 12.0
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$334.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.60
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$299.20
|
| Rate for Payer: First Health Commercial |
$316.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$316.80
|
| Rate for Payer: GEHA Commercial |
$246.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$316.80
|
| Rate for Payer: Multiplan All |
$320.32
|
| Rate for Payer: OMNI Networks Commercial |
$246.40
|
| Rate for Payer: One Health Plan PPO/POS |
$316.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$334.40
|
| Rate for Payer: Three Rivers Provider Network All |
$264.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$327.36
|
| Rate for Payer: Zelis Auto |
$140.80
|
|
|
IMPLT CATH SUPRAPUBIC SET 12.0
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$334.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$299.20
|
| Rate for Payer: First Health Commercial |
$316.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$316.80
|
| Rate for Payer: GEHA Commercial |
$281.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$316.80
|
| Rate for Payer: Humana ChoiceCare |
$91.52
|
| Rate for Payer: Multiplan All |
$320.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$211.20
|
| Rate for Payer: OMNI Networks Commercial |
$246.40
|
| Rate for Payer: One Health Plan PPO/POS |
$316.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$334.40
|
| Rate for Payer: Three Rivers Provider Network All |
$264.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$309.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$88.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$327.36
|
| Rate for Payer: Zelis Auto |
$140.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$176.00
|
|
|
IMPLT CATH SUPRAPUBIC SET 12.0
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$408.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$433.50
|
| Rate for Payer: First Health Commercial |
$459.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.00
|
| Rate for Payer: GEHA Commercial |
$357.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.00
|
| Rate for Payer: Multiplan All |
$464.10
|
| Rate for Payer: OMNI Networks Commercial |
$357.00
|
| Rate for Payer: One Health Plan PPO/POS |
$459.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$484.50
|
| Rate for Payer: Three Rivers Provider Network All |
$382.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$474.30
|
| Rate for Payer: Zelis Auto |
$204.00
|
|
|
IMPLT CATH SUPRAPUBIC SET 12.0
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT C2627
|
| Hospital Charge Code |
7002453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$433.50
|
| Rate for Payer: First Health Commercial |
$459.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.00
|
| Rate for Payer: GEHA Commercial |
$408.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.00
|
| Rate for Payer: Humana ChoiceCare |
$132.60
|
| Rate for Payer: Multiplan All |
$464.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$306.00
|
| Rate for Payer: OMNI Networks Commercial |
$357.00
|
| Rate for Payer: One Health Plan PPO/POS |
$459.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$484.50
|
| Rate for Payer: Three Rivers Provider Network All |
$382.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$448.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$474.30
|
| Rate for Payer: Zelis Auto |
$204.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$255.00
|
|
|
IMPLT CATH URETERAL FLEX TIP 6FRX70CM
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
7001696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.80 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$513.60
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cigna Commercial |
$545.70
|
| Rate for Payer: First Health Commercial |
$577.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$577.80
|
| Rate for Payer: GEHA Commercial |
$449.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$577.80
|
| Rate for Payer: Multiplan All |
$584.22
|
| Rate for Payer: OMNI Networks Commercial |
$449.40
|
| Rate for Payer: One Health Plan PPO/POS |
$577.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$609.90
|
| Rate for Payer: Three Rivers Provider Network All |
$481.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$597.06
|
| Rate for Payer: Zelis Auto |
$256.80
|
|
