|
IMPLT GUIDEWIRE .038 PTFE FLEXIBLE
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
|
|
IMPLT GUIDEWIRE .045X 6 INCH STAINLESS
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$113.60
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: First Health Commercial |
$127.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$127.80
|
| Rate for Payer: GEHA Commercial |
$99.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$127.80
|
| Rate for Payer: Multiplan All |
$129.22
|
| Rate for Payer: OMNI Networks Commercial |
$99.40
|
| Rate for Payer: One Health Plan PPO/POS |
$127.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$134.90
|
| Rate for Payer: Three Rivers Provider Network All |
$106.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.06
|
| Rate for Payer: Zelis Auto |
$56.80
|
|
|
IMPLT GUIDEWIRE .045X 6 INCH STAINLESS
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: First Health Commercial |
$127.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$127.80
|
| Rate for Payer: GEHA Commercial |
$113.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$127.80
|
| Rate for Payer: Humana ChoiceCare |
$36.92
|
| Rate for Payer: Multiplan All |
$129.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$85.20
|
| Rate for Payer: OMNI Networks Commercial |
$99.40
|
| Rate for Payer: One Health Plan PPO/POS |
$127.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$134.90
|
| Rate for Payer: Three Rivers Provider Network All |
$106.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$124.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.06
|
| Rate for Payer: Zelis Auto |
$56.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$71.00
|
|
|
IMPLT GUIDEWIRE 1.1X6MM
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$178.40
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$156.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: Zelis Auto |
$89.20
|
|
|
IMPLT GUIDEWIRE 1.1X6MM
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$178.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$57.98
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$133.80
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: Zelis Auto |
$89.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$111.50
|
|
|
IMPLT GUIDEWIRE 1.5X12 INCH
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna Commercial |
$576.30
|
| Rate for Payer: First Health Commercial |
$610.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$610.20
|
| Rate for Payer: GEHA Commercial |
$542.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$610.20
|
| Rate for Payer: Humana ChoiceCare |
$176.28
|
| Rate for Payer: Multiplan All |
$616.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$406.80
|
| Rate for Payer: OMNI Networks Commercial |
$474.60
|
| Rate for Payer: One Health Plan PPO/POS |
$610.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$644.10
|
| Rate for Payer: Three Rivers Provider Network All |
$508.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$596.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$169.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$630.54
|
| Rate for Payer: Zelis Auto |
$271.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$339.00
|
|
|
IMPLT GUIDEWIRE 1.5X12 INCH
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.20 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$542.40
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna Commercial |
$576.30
|
| Rate for Payer: First Health Commercial |
$610.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$610.20
|
| Rate for Payer: GEHA Commercial |
$474.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$610.20
|
| Rate for Payer: Multiplan All |
$616.98
|
| Rate for Payer: OMNI Networks Commercial |
$474.60
|
| Rate for Payer: One Health Plan PPO/POS |
$610.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$644.10
|
| Rate for Payer: Three Rivers Provider Network All |
$508.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$630.54
|
| Rate for Payer: Zelis Auto |
$271.20
|
|
|
IMPLT GUIDE WIRE 5/64 2MM
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$226.10
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$239.40
|
| Rate for Payer: GEHA Commercial |
$212.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$239.40
|
| Rate for Payer: Humana ChoiceCare |
$69.16
|
| Rate for Payer: Multiplan All |
$242.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$159.60
|
| Rate for Payer: OMNI Networks Commercial |
$186.20
|
| Rate for Payer: One Health Plan PPO/POS |
$239.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$252.70
|
| Rate for Payer: Three Rivers Provider Network All |
$199.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$234.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$247.38
|
| Rate for Payer: Zelis Auto |
$106.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$133.00
|
|
|
IMPLT GUIDE WIRE 5/64 2MM
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$212.80
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$226.10
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$239.40
|
| Rate for Payer: GEHA Commercial |
$186.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$239.40
|
| Rate for Payer: Multiplan All |
$242.06
|
| Rate for Payer: OMNI Networks Commercial |
$186.20
|
| Rate for Payer: One Health Plan PPO/POS |
$239.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$252.70
|
| Rate for Payer: Three Rivers Provider Network All |
$199.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$247.38
|
| Rate for Payer: Zelis Auto |
$106.40
|
|
|
IMPLT GUIDEWIRE AMPLATZ .035 640-104
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.80
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$158.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: Zelis Auto |
$90.40
|
|
|
IMPLT GUIDEWIRE AMPLATZ .035 640-104
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$180.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Humana ChoiceCare |
$58.76
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$135.60
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$198.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: Zelis Auto |
$90.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$113.00
|
|
|
IMPLT GUIDEWIRE AMPLATZ .038X145CM
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$334.40 |
| Max. Negotiated Rate |
$794.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$668.80
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$710.60
|
| Rate for Payer: First Health Commercial |
$752.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$752.40
|
| Rate for Payer: GEHA Commercial |
$585.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$752.40
|
| Rate for Payer: Multiplan All |
$760.76
|
| Rate for Payer: OMNI Networks Commercial |
$585.20
|
| Rate for Payer: One Health Plan PPO/POS |
$752.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$794.20
|
| Rate for Payer: Three Rivers Provider Network All |
$627.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$777.48
|
| Rate for Payer: Zelis Auto |
$334.40
|
|
|
IMPLT GUIDEWIRE AMPLATZ .038X145CM
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$209.00 |
| Max. Negotiated Rate |
$794.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$710.60
|
| Rate for Payer: First Health Commercial |
$752.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$752.40
|
| Rate for Payer: GEHA Commercial |
$668.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$752.40
|
| Rate for Payer: Humana ChoiceCare |
$217.36
|
| Rate for Payer: Multiplan All |
$760.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$501.60
|
| Rate for Payer: OMNI Networks Commercial |
$585.20
|
| Rate for Payer: One Health Plan PPO/POS |
$752.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$794.20
|
| Rate for Payer: Three Rivers Provider Network All |
$627.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$735.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$209.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$777.48
|
| Rate for Payer: Zelis Auto |
$334.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$418.00
|
|
|
IMPLT GUIDEWIRE ANGLED TIP .035IN.
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001732
|
|
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 GUIDEWIRE ANGLED TIP .035IN.
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001732
|
|
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 GUIDEWIRE ANGLED TIP.038IN.
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.80
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$255.85
|
| Rate for Payer: First Health Commercial |
$270.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.90
|
| Rate for Payer: GEHA Commercial |
$210.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.90
|
| Rate for Payer: Multiplan All |
$273.91
|
| Rate for Payer: OMNI Networks Commercial |
$210.70
|
| Rate for Payer: One Health Plan PPO/POS |
$270.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.95
|
| Rate for Payer: Three Rivers Provider Network All |
$225.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.93
|
| Rate for Payer: Zelis Auto |
$120.40
|
|
|
IMPLT GUIDEWIRE ANGLED TIP.038IN.
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$255.85
|
| Rate for Payer: First Health Commercial |
$270.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.90
|
| Rate for Payer: GEHA Commercial |
$240.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.90
|
| Rate for Payer: Humana ChoiceCare |
$78.26
|
| Rate for Payer: Multiplan All |
$273.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$180.60
|
| Rate for Payer: OMNI Networks Commercial |
$210.70
|
| Rate for Payer: One Health Plan PPO/POS |
$270.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.95
|
| Rate for Payer: Three Rivers Provider Network All |
$225.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$264.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.93
|
| Rate for Payer: Zelis Auto |
$120.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$150.50
|
|
|
IMPLT GUIDEWIRE BLUNT TIP 1.0X305
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$188.80
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$200.60
|
| Rate for Payer: First Health Commercial |
$212.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$212.40
|
| Rate for Payer: GEHA Commercial |
$165.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$212.40
|
| Rate for Payer: Multiplan All |
$214.76
|
| Rate for Payer: OMNI Networks Commercial |
$165.20
|
| Rate for Payer: One Health Plan PPO/POS |
$212.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$224.20
|
| Rate for Payer: Three Rivers Provider Network All |
$177.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$219.48
|
| Rate for Payer: Zelis Auto |
$94.40
|
|
|
IMPLT GUIDEWIRE BLUNT TIP 1.0X305
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$200.60
|
| Rate for Payer: First Health Commercial |
$212.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$212.40
|
| Rate for Payer: GEHA Commercial |
$188.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$212.40
|
| Rate for Payer: Humana ChoiceCare |
$61.36
|
| Rate for Payer: Multiplan All |
$214.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$141.60
|
| Rate for Payer: OMNI Networks Commercial |
$165.20
|
| Rate for Payer: One Health Plan PPO/POS |
$212.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$224.20
|
| Rate for Payer: Three Rivers Provider Network All |
$177.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$207.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$219.48
|
| Rate for Payer: Zelis Auto |
$94.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$118.00
|
|
|
IMPLT GUIDEWIRE ENDO .035IN 145CM
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$276.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$241.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
|
|
IMPLT GUIDEWIRE ENDO .035IN 145CM
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$276.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$89.70
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$207.00
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$303.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$172.50
|
|
|
IMPLT GUIDE WIRE HYDROPHILIC 25X150MM
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.60 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$711.20
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$622.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: Zelis Auto |
$355.60
|
|
|
IMPLT GUIDE WIRE HYDROPHILIC 25X150MM
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.25 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$711.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| Rate for Payer: Humana ChoiceCare |
$231.14
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$533.40
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$782.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$222.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: Zelis Auto |
$355.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$444.50
|
|
|
IMPLT GUIDE WIRE ROADRUNNER 35X145MM
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$185.60
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
|
|
IMPLT GUIDE WIRE ROADRUNNER 35X145MM
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$185.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Humana ChoiceCare |
$60.32
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$139.20
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$204.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$58.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$116.00
|
|
