|
IMPLT CURCIATE FEMORAL SZ4 RIGHT
|
Facility
|
OP
|
$7,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,806.25 |
| Max. Negotiated Rate |
$6,863.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,335.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cigna Commercial |
$6,141.25
|
| Rate for Payer: First Health Commercial |
$6,502.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,502.50
|
| Rate for Payer: GEHA Commercial |
$5,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,502.50
|
| Rate for Payer: Humana ChoiceCare |
$1,878.50
|
| Rate for Payer: Multiplan All |
$6,574.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,335.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,057.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,502.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,863.75
|
| Rate for Payer: Three Rivers Provider Network All |
$5,418.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,358.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,806.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,719.25
|
| Rate for Payer: Zelis Auto |
$2,890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,612.50
|
|
|
IMPLT CVC CATH CORDIS SINGLE LUM
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
7001683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$273.60
|
| Rate for Payer: GEHA Commercial |
$243.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$273.60
|
| Rate for Payer: Humana ChoiceCare |
$79.04
|
| Rate for Payer: Multiplan All |
$276.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$182.40
|
| Rate for Payer: OMNI Networks Commercial |
$212.80
|
| Rate for Payer: One Health Plan PPO/POS |
$273.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$288.80
|
| Rate for Payer: Three Rivers Provider Network All |
$228.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$267.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$282.72
|
| Rate for Payer: Zelis Auto |
$121.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.00
|
|
|
IMPLT CVC CATH CORDIS SINGLE LUM
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
7001683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$243.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$273.60
|
| Rate for Payer: GEHA Commercial |
$212.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$273.60
|
| Rate for Payer: Multiplan All |
$276.64
|
| Rate for Payer: OMNI Networks Commercial |
$212.80
|
| Rate for Payer: One Health Plan PPO/POS |
$273.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$288.80
|
| Rate for Payer: Three Rivers Provider Network All |
$228.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$282.72
|
| Rate for Payer: Zelis Auto |
$121.60
|
|
|
IMPLT DEL SYSTEM DISTAL BICEPS BC
|
Facility
|
OP
|
$5,548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.00 |
| Max. Negotiated Rate |
$5,270.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,328.80
|
| Rate for Payer: Cash Price |
$3,328.80
|
| Rate for Payer: Cash Price |
$3,328.80
|
| Rate for Payer: Cigna Commercial |
$4,715.80
|
| Rate for Payer: First Health Commercial |
$4,993.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,993.20
|
| Rate for Payer: GEHA Commercial |
$4,438.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,993.20
|
| Rate for Payer: Humana ChoiceCare |
$1,442.48
|
| Rate for Payer: Multiplan All |
$5,048.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,328.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,883.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,993.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,270.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,161.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,882.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,387.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,159.64
|
| Rate for Payer: Zelis Auto |
$2,219.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,774.00
|
|
|
IMPLT DEL SYSTEM DISTAL BICEPS BC
|
Facility
|
IP
|
$5,548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,219.20 |
| Max. Negotiated Rate |
$5,270.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,438.40
|
| Rate for Payer: Cash Price |
$3,328.80
|
| Rate for Payer: Cash Price |
$3,328.80
|
| Rate for Payer: Cigna Commercial |
$4,715.80
|
| Rate for Payer: First Health Commercial |
$4,993.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,993.20
|
| Rate for Payer: GEHA Commercial |
$3,883.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,993.20
|
| Rate for Payer: Multiplan All |
$5,048.68
|
| Rate for Payer: OMNI Networks Commercial |
$3,883.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,993.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,270.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,161.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,159.64
|
| Rate for Payer: Zelis Auto |
$2,219.20
|
|
|
IMPLT DEL SYSTEM DISTAL BICEPS REPAIR
|
Facility
|
OP
|
$4,461.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.25 |
| Max. Negotiated Rate |
$4,237.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,676.60
|
| Rate for Payer: Cash Price |
$2,676.60
|
| Rate for Payer: Cash Price |
$2,676.60
|
| Rate for Payer: Cigna Commercial |
$3,791.85
|
| Rate for Payer: First Health Commercial |
$4,014.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,014.90
|
| Rate for Payer: GEHA Commercial |
$3,568.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,014.90
|
| Rate for Payer: Humana ChoiceCare |
$1,159.86
|
| Rate for Payer: Multiplan All |
$4,059.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,676.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,122.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,014.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,237.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,345.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,925.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,115.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,148.73
|
| Rate for Payer: Zelis Auto |
$1,784.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,230.50
|
|
|
IMPLT DEL SYSTEM DISTAL BICEPS REPAIR
|
Facility
|
IP
|
$4,461.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,784.40 |
| Max. Negotiated Rate |
$4,237.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,568.80
|
| Rate for Payer: Cash Price |
$2,676.60
|
| Rate for Payer: Cash Price |
$2,676.60
|
| Rate for Payer: Cigna Commercial |
$3,791.85
|
| Rate for Payer: First Health Commercial |
$4,014.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,014.90
|
| Rate for Payer: GEHA Commercial |
$3,122.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,014.90
|
| Rate for Payer: Multiplan All |
$4,059.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,122.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,014.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,237.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,345.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,148.73
|
| Rate for Payer: Zelis Auto |
$1,784.40
|
|
|
IMPLT DEVICE MONODEK ABSORBABLE
|
Facility
|
OP
|
$1,953.00
|
|
|
Service Code
|
CPT C2631
|
| Hospital Charge Code |
7002740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.25 |
| Max. Negotiated Rate |
$1,855.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna Commercial |
$1,660.05
|
| Rate for Payer: First Health Commercial |
$1,757.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,757.70
|
| Rate for Payer: GEHA Commercial |
$1,562.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,757.70
|
| Rate for Payer: Humana ChoiceCare |
$507.78
|
| Rate for Payer: Multiplan All |
$1,777.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,171.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,367.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,757.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,855.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,464.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,718.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$488.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,816.29
|
| Rate for Payer: Zelis Auto |
$781.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$976.50
|
|
|
IMPLT DEVICE MONODEK ABSORBABLE
|
Facility
|
IP
|
$1,953.00
|
|
|
Service Code
|
CPT C2631
|
| Hospital Charge Code |
7002740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$781.20 |
| Max. Negotiated Rate |
$1,855.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,562.40
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna Commercial |
$1,660.05
|
| Rate for Payer: First Health Commercial |
$1,757.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,757.70
|
| Rate for Payer: GEHA Commercial |
$1,367.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,757.70
|
| Rate for Payer: Multiplan All |
$1,777.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,367.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,757.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,855.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,464.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,816.29
|
| Rate for Payer: Zelis Auto |
$781.20
|
|
|
IMPLT DEVICE O-PROLENE
|
Facility
|
OP
|
$1,953.00
|
|
|
Service Code
|
CPT C2631
|
| Hospital Charge Code |
7002827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.25 |
| Max. Negotiated Rate |
$1,855.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna Commercial |
$1,660.05
|
| Rate for Payer: First Health Commercial |
$1,757.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,757.70
|
| Rate for Payer: GEHA Commercial |
$1,562.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,757.70
|
| Rate for Payer: Humana ChoiceCare |
$507.78
|
| Rate for Payer: Multiplan All |
$1,777.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,171.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,367.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,757.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,855.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,464.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,718.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$488.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,816.29
|
| Rate for Payer: Zelis Auto |
$781.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$976.50
|
|
|
IMPLT DEVICE O-PROLENE
|
Facility
|
IP
|
$1,953.00
|
|
|
Service Code
|
CPT C2631
|
| Hospital Charge Code |
7002827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$781.20 |
| Max. Negotiated Rate |
$1,855.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,562.40
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna Commercial |
$1,660.05
|
| Rate for Payer: First Health Commercial |
$1,757.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,757.70
|
| Rate for Payer: GEHA Commercial |
$1,367.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,757.70
|
| Rate for Payer: Multiplan All |
$1,777.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,367.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,757.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,855.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,464.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,816.29
|
| Rate for Payer: Zelis Auto |
$781.20
|
|
|
IMPLT DEVICE TOGGLELOC FIXATION
|
Facility
|
IP
|
$2,259.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.60 |
| Max. Negotiated Rate |
$2,146.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,807.20
|
| Rate for Payer: Cash Price |
$1,355.40
|
| Rate for Payer: Cash Price |
$1,355.40
|
| Rate for Payer: Cigna Commercial |
$1,920.15
|
| Rate for Payer: First Health Commercial |
$2,033.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,033.10
|
| Rate for Payer: GEHA Commercial |
$1,581.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,033.10
|
| Rate for Payer: Multiplan All |
$2,055.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,581.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,033.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,146.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,694.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,100.87
|
| Rate for Payer: Zelis Auto |
$903.60
|
|
|
IMPLT DEVICE TOGGLELOC FIXATION
|
Facility
|
OP
|
$2,259.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.75 |
| Max. Negotiated Rate |
$2,146.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,355.40
|
| Rate for Payer: Cash Price |
$1,355.40
|
| Rate for Payer: Cash Price |
$1,355.40
|
| Rate for Payer: Cigna Commercial |
$1,920.15
|
| Rate for Payer: First Health Commercial |
$2,033.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,033.10
|
| Rate for Payer: GEHA Commercial |
$1,807.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,033.10
|
| Rate for Payer: Humana ChoiceCare |
$587.34
|
| Rate for Payer: Multiplan All |
$2,055.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,355.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,581.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,033.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,146.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,694.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,987.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$564.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,100.87
|
| Rate for Payer: Zelis Auto |
$903.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,129.50
|
|
|
IMPLT DILATION BALLOON 15FX4CM
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7002587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.80 |
| Max. Negotiated Rate |
$1,217.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,025.60
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$1,089.70
|
| Rate for Payer: First Health Commercial |
$1,153.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,153.80
|
| Rate for Payer: GEHA Commercial |
$897.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,153.80
|
| Rate for Payer: Multiplan All |
$1,166.62
|
| Rate for Payer: OMNI Networks Commercial |
$897.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,153.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,217.90
|
| Rate for Payer: Three Rivers Provider Network All |
$961.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,192.26
|
| Rate for Payer: Zelis Auto |
$512.80
|
|
|
IMPLT DILATION BALLOON 15FX4CM
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7002587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.50 |
| Max. Negotiated Rate |
$1,217.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$769.20
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$1,089.70
|
| Rate for Payer: First Health Commercial |
$1,153.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,153.80
|
| Rate for Payer: GEHA Commercial |
$1,025.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,153.80
|
| Rate for Payer: Humana ChoiceCare |
$333.32
|
| Rate for Payer: Multiplan All |
$1,166.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$769.20
|
| Rate for Payer: OMNI Networks Commercial |
$897.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,153.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,217.90
|
| Rate for Payer: Three Rivers Provider Network All |
$961.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,128.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,192.26
|
| Rate for Payer: Zelis Auto |
$512.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$641.00
|
|
|
IMPLT DILATOR G10284 6FR
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: First Health Commercial |
$115.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$115.20
|
| Rate for Payer: GEHA Commercial |
$102.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$115.20
|
| Rate for Payer: Humana ChoiceCare |
$33.28
|
| Rate for Payer: Multiplan All |
$116.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$76.80
|
| Rate for Payer: OMNI Networks Commercial |
$89.60
|
| Rate for Payer: One Health Plan PPO/POS |
$115.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$121.60
|
| Rate for Payer: Three Rivers Provider Network All |
$96.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$112.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$32.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.04
|
| Rate for Payer: Zelis Auto |
$51.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$64.00
|
|
|
IMPLT DILATOR G10284 6FR
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.40
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: First Health Commercial |
$115.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$115.20
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$115.20
|
| Rate for Payer: Multiplan All |
$116.48
|
| Rate for Payer: OMNI Networks Commercial |
$89.60
|
| Rate for Payer: One Health Plan PPO/POS |
$115.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$121.60
|
| Rate for Payer: Three Rivers Provider Network All |
$96.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.04
|
| Rate for Payer: Zelis Auto |
$51.20
|
|
|
IMPLT DILATOR G10290
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$31.72
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$73.20
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$107.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.00
|
|
|
IMPLT DILATOR G10290
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.60
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$85.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
|
|
IMPLT DILATOR SET AMPLATZ RENAL
|
Facility
|
IP
|
$1,033.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.20 |
| Max. Negotiated Rate |
$981.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$826.40
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cigna Commercial |
$878.05
|
| Rate for Payer: First Health Commercial |
$929.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$929.70
|
| Rate for Payer: GEHA Commercial |
$723.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$929.70
|
| Rate for Payer: Multiplan All |
$940.03
|
| Rate for Payer: OMNI Networks Commercial |
$723.10
|
| Rate for Payer: One Health Plan PPO/POS |
$929.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$981.35
|
| Rate for Payer: Three Rivers Provider Network All |
$774.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$960.69
|
| Rate for Payer: Zelis Auto |
$413.20
|
|
|
IMPLT DILATOR SET AMPLATZ RENAL
|
Facility
|
OP
|
$1,033.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.25 |
| Max. Negotiated Rate |
$981.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$619.80
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cigna Commercial |
$878.05
|
| Rate for Payer: First Health Commercial |
$929.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$929.70
|
| Rate for Payer: GEHA Commercial |
$826.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$929.70
|
| Rate for Payer: Humana ChoiceCare |
$268.58
|
| Rate for Payer: Multiplan All |
$940.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$619.80
|
| Rate for Payer: OMNI Networks Commercial |
$723.10
|
| Rate for Payer: One Health Plan PPO/POS |
$929.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$981.35
|
| Rate for Payer: Three Rivers Provider Network All |
$774.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$909.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$258.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$960.69
|
| Rate for Payer: Zelis Auto |
$413.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$516.50
|
|
|
IMPLT DISTAL FIB PLATE
|
Facility
|
IP
|
$4,918.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,967.20 |
| Max. Negotiated Rate |
$4,672.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,934.40
|
| Rate for Payer: Cash Price |
$2,950.80
|
| Rate for Payer: Cash Price |
$2,950.80
|
| Rate for Payer: Cigna Commercial |
$4,180.30
|
| Rate for Payer: First Health Commercial |
$4,426.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,426.20
|
| Rate for Payer: GEHA Commercial |
$3,442.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,426.20
|
| Rate for Payer: Multiplan All |
$4,475.38
|
| Rate for Payer: OMNI Networks Commercial |
$3,442.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,426.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,672.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,688.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,573.74
|
| Rate for Payer: Zelis Auto |
$1,967.20
|
|
|
IMPLT DISTAL FIB PLATE
|
Facility
|
OP
|
$4,918.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$4,672.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,950.80
|
| Rate for Payer: Cash Price |
$2,950.80
|
| Rate for Payer: Cash Price |
$2,950.80
|
| Rate for Payer: Cigna Commercial |
$4,180.30
|
| Rate for Payer: First Health Commercial |
$4,426.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,426.20
|
| Rate for Payer: GEHA Commercial |
$3,934.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,426.20
|
| Rate for Payer: Humana ChoiceCare |
$1,278.68
|
| Rate for Payer: Multiplan All |
$4,475.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,950.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,442.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,426.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,672.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,688.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,327.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,229.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,573.74
|
| Rate for Payer: Zelis Auto |
$1,967.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,459.00
|
|
|
IMPLT DX FIBRTK
|
Facility
|
OP
|
$2,621.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.44 |
| Max. Negotiated Rate |
$2,490.67 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,573.06
|
| Rate for Payer: Cash Price |
$1,573.06
|
| Rate for Payer: Cash Price |
$1,573.06
|
| Rate for Payer: Cigna Commercial |
$2,228.50
|
| Rate for Payer: First Health Commercial |
$2,359.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,359.58
|
| Rate for Payer: GEHA Commercial |
$2,097.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,359.58
|
| Rate for Payer: Humana ChoiceCare |
$681.66
|
| Rate for Payer: Multiplan All |
$2,385.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,573.06
|
| Rate for Payer: OMNI Networks Commercial |
$1,835.23
|
| Rate for Payer: One Health Plan PPO/POS |
$2,359.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,490.67
|
| Rate for Payer: Three Rivers Provider Network All |
$1,966.32
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,307.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$655.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,438.24
|
| Rate for Payer: Zelis Auto |
$1,048.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,310.88
|
|
|
IMPLT DX FIBRTK
|
Facility
|
IP
|
$2,621.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,048.70 |
| Max. Negotiated Rate |
$2,490.67 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,097.41
|
| Rate for Payer: Cash Price |
$1,573.06
|
| Rate for Payer: Cash Price |
$1,573.06
|
| Rate for Payer: Cigna Commercial |
$2,228.50
|
| Rate for Payer: First Health Commercial |
$2,359.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,359.58
|
| Rate for Payer: GEHA Commercial |
$1,835.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,359.58
|
| Rate for Payer: Multiplan All |
$2,385.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,835.23
|
| Rate for Payer: One Health Plan PPO/POS |
$2,359.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,490.67
|
| Rate for Payer: Three Rivers Provider Network All |
$1,966.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,438.24
|
| Rate for Payer: Zelis Auto |
$1,048.70
|
|
