|
IMPLT GUIDE WIRE ROADRUNNER NIMBLE
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$173.60
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$151.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: Zelis Auto |
$86.80
|
|
|
IMPLT GUIDE WIRE ROADRUNNER NIMBLE
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.25 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Humana ChoiceCare |
$56.42
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$130.20
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$190.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$54.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$108.50
|
|
|
IMPLT GUIDE WIRE ROSEN CURVED
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$110.40
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
|
|
IMPLT GUIDE WIRE ROSEN CURVED
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$35.88
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$82.80
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$121.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.00
|
|
|
IMPLT GUIDEWIRE STRAIGHT 0.38
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$386.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.60
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$284.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: Zelis Auto |
$162.80
|
|
|
IMPLT GUIDEWIRE STRAIGHT 0.38
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.75 |
| Max. Negotiated Rate |
$386.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$325.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Humana ChoiceCare |
$105.82
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.20
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$358.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$101.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$203.50
|
|
|
IMPLT GUIDE WIRE SUBTALAR 8 INCH
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001712
|
|
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 GUIDE WIRE SUBTALAR 8 INCH
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001712
|
|
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 GUIDE WIRE TORQ-FLEX
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$87.36
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.60
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.00
|
|
|
IMPLT GUIDE WIRE TORQ-FLEX
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
|
|
IMPLT GUIDEWRE 1.2X12MM
|
Facility
|
OP
|
$271.00
|
|
| Hospital Charge Code |
90080179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.75 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$230.35
|
| Rate for Payer: First Health Commercial |
$243.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.90
|
| Rate for Payer: GEHA Commercial |
$216.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.90
|
| Rate for Payer: Humana ChoiceCare |
$70.46
|
| Rate for Payer: Multiplan All |
$246.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$162.60
|
| Rate for Payer: OMNI Networks Commercial |
$189.70
|
| Rate for Payer: One Health Plan PPO/POS |
$243.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$257.45
|
| Rate for Payer: Three Rivers Provider Network All |
$203.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$238.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.03
|
| Rate for Payer: Zelis Auto |
$108.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$135.50
|
|
|
IMPLT GUIDEWRE 1.2X12MM
|
Facility
|
IP
|
$271.00
|
|
| Hospital Charge Code |
90080179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.40 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$216.80
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$230.35
|
| Rate for Payer: First Health Commercial |
$243.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.90
|
| Rate for Payer: GEHA Commercial |
$189.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.90
|
| Rate for Payer: Multiplan All |
$246.61
|
| Rate for Payer: OMNI Networks Commercial |
$189.70
|
| Rate for Payer: One Health Plan PPO/POS |
$243.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$257.45
|
| Rate for Payer: Three Rivers Provider Network All |
$203.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.03
|
| Rate for Payer: Zelis Auto |
$108.40
|
|
|
IMPLT GUIDWIRE 900.722
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$232.80
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$247.35
|
| Rate for Payer: First Health Commercial |
$261.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.90
|
| Rate for Payer: GEHA Commercial |
$203.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.90
|
| Rate for Payer: Multiplan All |
$264.81
|
| Rate for Payer: OMNI Networks Commercial |
$203.70
|
| Rate for Payer: One Health Plan PPO/POS |
$261.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$276.45
|
| Rate for Payer: Three Rivers Provider Network All |
$218.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$270.63
|
| Rate for Payer: Zelis Auto |
$116.40
|
|
|
IMPLT GUIDWIRE 900.722
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$247.35
|
| Rate for Payer: First Health Commercial |
$261.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.90
|
| Rate for Payer: GEHA Commercial |
$232.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.90
|
| Rate for Payer: Humana ChoiceCare |
$75.66
|
| Rate for Payer: Multiplan All |
$264.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$174.60
|
| Rate for Payer: OMNI Networks Commercial |
$203.70
|
| Rate for Payer: One Health Plan PPO/POS |
$261.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$276.45
|
| Rate for Payer: Three Rivers Provider Network All |
$218.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$256.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$72.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$270.63
|
| Rate for Payer: Zelis Auto |
$116.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$145.50
|
|
|
IMPLT GWIRE 1.2 X 18MM
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7006652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$279.20
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$296.65
|
| Rate for Payer: First Health Commercial |
$314.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$314.10
|
| Rate for Payer: GEHA Commercial |
$244.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$314.10
|
| Rate for Payer: Multiplan All |
$317.59
|
| Rate for Payer: OMNI Networks Commercial |
$244.30
|
| Rate for Payer: One Health Plan PPO/POS |
$314.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$331.55
|
| Rate for Payer: Three Rivers Provider Network All |
$261.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$324.57
|
| Rate for Payer: Zelis Auto |
$139.60
|
|
|
IMPLT GWIRE 1.2 X 18MM
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7006652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.25 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$296.65
|
| Rate for Payer: First Health Commercial |
$314.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$314.10
|
| Rate for Payer: GEHA Commercial |
$279.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$314.10
|
| Rate for Payer: Humana ChoiceCare |
$90.74
|
| Rate for Payer: Multiplan All |
$317.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$209.40
|
| Rate for Payer: OMNI Networks Commercial |
$244.30
|
| Rate for Payer: One Health Plan PPO/POS |
$314.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$331.55
|
| Rate for Payer: Three Rivers Provider Network All |
$261.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$307.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$87.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$324.57
|
| Rate for Payer: Zelis Auto |
$139.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$174.50
|
|
|
IMPLT GWIRE DRL TP 2.4X10 NEW# 90080178
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.25 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$296.65
|
| Rate for Payer: First Health Commercial |
$314.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$314.10
|
| Rate for Payer: GEHA Commercial |
$279.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$314.10
|
| Rate for Payer: Humana ChoiceCare |
$90.74
|
| Rate for Payer: Multiplan All |
$317.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$209.40
|
| Rate for Payer: OMNI Networks Commercial |
$244.30
|
| Rate for Payer: One Health Plan PPO/POS |
$314.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$331.55
|
| Rate for Payer: Three Rivers Provider Network All |
$261.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$307.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$87.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$324.57
|
| Rate for Payer: Zelis Auto |
$139.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$174.50
|
|
|
IMPLT GWIRE DRL TP 2.4X10 NEW# 90080178
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$279.20
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$296.65
|
| Rate for Payer: First Health Commercial |
$314.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$314.10
|
| Rate for Payer: GEHA Commercial |
$244.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$314.10
|
| Rate for Payer: Multiplan All |
$317.59
|
| Rate for Payer: OMNI Networks Commercial |
$244.30
|
| Rate for Payer: One Health Plan PPO/POS |
$314.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$331.55
|
| Rate for Payer: Three Rivers Provider Network All |
$261.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$324.57
|
| Rate for Payer: Zelis Auto |
$139.60
|
|
|
IMPLT HEAD BIOLOX OPTION 36MM +7
|
Facility
|
OP
|
$7,645.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,911.25 |
| Max. Negotiated Rate |
$7,262.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,587.00
|
| Rate for Payer: Cash Price |
$4,587.00
|
| Rate for Payer: Cash Price |
$4,587.00
|
| Rate for Payer: Cigna Commercial |
$6,498.25
|
| Rate for Payer: First Health Commercial |
$6,880.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,880.50
|
| Rate for Payer: GEHA Commercial |
$6,116.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,880.50
|
| Rate for Payer: Humana ChoiceCare |
$1,987.70
|
| Rate for Payer: Multiplan All |
$6,956.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,587.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,351.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,880.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,262.75
|
| Rate for Payer: Three Rivers Provider Network All |
$5,733.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,727.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,109.85
|
| Rate for Payer: Zelis Auto |
$3,058.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,822.50
|
|
|
IMPLT HEAD BIOLOX OPTION 36MM +7
|
Facility
|
IP
|
$7,645.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.00 |
| Max. Negotiated Rate |
$7,262.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,116.00
|
| Rate for Payer: Cash Price |
$4,587.00
|
| Rate for Payer: Cash Price |
$4,587.00
|
| Rate for Payer: Cigna Commercial |
$6,498.25
|
| Rate for Payer: First Health Commercial |
$6,880.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,880.50
|
| Rate for Payer: GEHA Commercial |
$5,351.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,880.50
|
| Rate for Payer: Multiplan All |
$6,956.95
|
| Rate for Payer: OMNI Networks Commercial |
$5,351.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,880.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,262.75
|
| Rate for Payer: Three Rivers Provider Network All |
$5,733.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,109.85
|
| Rate for Payer: Zelis Auto |
$3,058.00
|
|
|
IMPLT HEAD BIOMODULAR 48X19MM
|
Facility
|
IP
|
$8,355.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,342.00 |
| Max. Negotiated Rate |
$7,937.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,684.00
|
| Rate for Payer: Cash Price |
$5,013.00
|
| Rate for Payer: Cash Price |
$5,013.00
|
| Rate for Payer: Cigna Commercial |
$7,101.75
|
| Rate for Payer: First Health Commercial |
$7,519.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,519.50
|
| Rate for Payer: GEHA Commercial |
$5,848.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,519.50
|
| Rate for Payer: Multiplan All |
$7,603.05
|
| Rate for Payer: OMNI Networks Commercial |
$5,848.50
|
| Rate for Payer: One Health Plan PPO/POS |
$7,519.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,937.25
|
| Rate for Payer: Three Rivers Provider Network All |
$6,266.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,770.15
|
| Rate for Payer: Zelis Auto |
$3,342.00
|
|
|
IMPLT HEAD BIOMODULAR 48X19MM
|
Facility
|
OP
|
$8,355.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,088.75 |
| Max. Negotiated Rate |
$7,937.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,013.00
|
| Rate for Payer: Cash Price |
$5,013.00
|
| Rate for Payer: Cash Price |
$5,013.00
|
| Rate for Payer: Cigna Commercial |
$7,101.75
|
| Rate for Payer: First Health Commercial |
$7,519.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,519.50
|
| Rate for Payer: GEHA Commercial |
$6,684.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,519.50
|
| Rate for Payer: Humana ChoiceCare |
$2,172.30
|
| Rate for Payer: Multiplan All |
$7,603.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,013.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,848.50
|
| Rate for Payer: One Health Plan PPO/POS |
$7,519.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,937.25
|
| Rate for Payer: Three Rivers Provider Network All |
$6,266.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,352.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,088.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,770.15
|
| Rate for Payer: Zelis Auto |
$3,342.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,177.50
|
|
|
IMPLT HEAD BIPOLAR 26MM
|
Facility
|
IP
|
$2,081.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$832.40 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,664.80
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,456.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
|
|
IMPLT HEAD BIPOLAR 26MM
|
Facility
|
OP
|
$2,081.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.25 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,664.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Humana ChoiceCare |
$541.06
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,248.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,831.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,040.50
|
|
|
IMPLT HEAD BIPOLAR 44MM UNIVERSAL
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.25 |
| Max. Negotiated Rate |
$2,113.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$1,891.25
|
| Rate for Payer: First Health Commercial |
$2,002.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,002.50
|
| Rate for Payer: GEHA Commercial |
$1,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,002.50
|
| Rate for Payer: Humana ChoiceCare |
$578.50
|
| Rate for Payer: Multiplan All |
$2,024.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,335.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,557.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,002.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,113.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,958.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$556.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,069.25
|
| Rate for Payer: Zelis Auto |
$890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,112.50
|
|
