|
IMPLT INTERPHALANGEAL PROXIMAL SILICONE
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.00 |
| Max. Negotiated Rate |
$4,750.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,000.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cigna Commercial |
$4,250.00
|
| Rate for Payer: First Health Commercial |
$4,500.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,500.00
|
| Rate for Payer: GEHA Commercial |
$3,500.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,500.00
|
| Rate for Payer: Multiplan All |
$4,550.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,500.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,500.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,750.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,750.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,650.00
|
| Rate for Payer: Zelis Auto |
$2,000.00
|
|
|
IMPLT INTRODUCERS 20FR LRG PEEL AWAY
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$260.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Humana ChoiceCare |
$84.76
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$195.60
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$286.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$163.00
|
|
|
IMPLT INTRODUCERS 20FR LRG PEEL AWAY
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$260.80
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$228.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
|
|
IMPLT INTRODUCERS 22FR LRG PEEL AWAY
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$260.80
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$228.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
|
|
IMPLT INTRODUCERS 22FR LRG PEEL AWAY
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$260.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Humana ChoiceCare |
$84.76
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$195.60
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$286.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$163.00
|
|
|
IMPLT INTRODUCER SET 12FR PEEL-AWAY
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$289.00
|
| Rate for Payer: First Health Commercial |
$306.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.00
|
| Rate for Payer: GEHA Commercial |
$272.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.00
|
| Rate for Payer: Humana ChoiceCare |
$88.40
|
| Rate for Payer: Multiplan All |
$309.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$204.00
|
| Rate for Payer: OMNI Networks Commercial |
$238.00
|
| Rate for Payer: One Health Plan PPO/POS |
$306.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.00
|
| Rate for Payer: Three Rivers Provider Network All |
$255.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$299.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$85.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$316.20
|
| Rate for Payer: Zelis Auto |
$136.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$170.00
|
|
|
IMPLT INTRODUCER SET 12FR PEEL-AWAY
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$272.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$289.00
|
| Rate for Payer: First Health Commercial |
$306.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.00
|
| Rate for Payer: GEHA Commercial |
$238.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.00
|
| Rate for Payer: Multiplan All |
$309.40
|
| Rate for Payer: OMNI Networks Commercial |
$238.00
|
| Rate for Payer: One Health Plan PPO/POS |
$306.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.00
|
| Rate for Payer: Three Rivers Provider Network All |
$255.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$316.20
|
| Rate for Payer: Zelis Auto |
$136.00
|
|
|
IMPLT INTRODUCER SET 14 FR PEEL AWAY
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$79.30
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.00
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$268.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.50
|
|
|
IMPLT INTRODUCER SET 14 FR PEEL AWAY
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
|
|
IMPLT INTRODUCER SET 16 FR PEEL AWAY
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
|
|
IMPLT INTRODUCER SET 16 FR PEEL AWAY
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$79.30
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.00
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$268.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.50
|
|
|
IMPLT INTRODUCER SET 5.5FR CHECK-FLO
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$147.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: First Health Commercial |
$165.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$165.60
|
| Rate for Payer: GEHA Commercial |
$128.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$165.60
|
| Rate for Payer: Multiplan All |
$167.44
|
| Rate for Payer: OMNI Networks Commercial |
$128.80
|
| Rate for Payer: One Health Plan PPO/POS |
$165.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$174.80
|
| Rate for Payer: Three Rivers Provider Network All |
$138.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$171.12
|
| Rate for Payer: Zelis Auto |
$73.60
|
|
|
IMPLT INTRODUCER SET 5.5FR CHECK-FLO
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: First Health Commercial |
$165.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$165.60
|
| Rate for Payer: GEHA Commercial |
$147.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$165.60
|
| Rate for Payer: Humana ChoiceCare |
$47.84
|
| Rate for Payer: Multiplan All |
$167.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$110.40
|
| Rate for Payer: OMNI Networks Commercial |
$128.80
|
| Rate for Payer: One Health Plan PPO/POS |
$165.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$174.80
|
| Rate for Payer: Three Rivers Provider Network All |
$138.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$161.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$171.12
|
| Rate for Payer: Zelis Auto |
$73.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$92.00
|
|
|
IMPLT INTRODUCER SET 5FR CHECK-FLO
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$301.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$253.60
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$269.45
|
| Rate for Payer: First Health Commercial |
$285.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$285.30
|
| Rate for Payer: GEHA Commercial |
$221.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$285.30
|
| Rate for Payer: Multiplan All |
$288.47
|
| Rate for Payer: OMNI Networks Commercial |
$221.90
|
| Rate for Payer: One Health Plan PPO/POS |
$285.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$301.15
|
| Rate for Payer: Three Rivers Provider Network All |
$237.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$294.81
|
| Rate for Payer: Zelis Auto |
$126.80
|
|
|
IMPLT INTRODUCER SET 5FR CHECK-FLO
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$301.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$190.20
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$269.45
|
| Rate for Payer: First Health Commercial |
$285.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$285.30
|
| Rate for Payer: GEHA Commercial |
$253.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$285.30
|
| Rate for Payer: Humana ChoiceCare |
$82.42
|
| Rate for Payer: Multiplan All |
$288.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$190.20
|
| Rate for Payer: OMNI Networks Commercial |
$221.90
|
| Rate for Payer: One Health Plan PPO/POS |
$285.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$301.15
|
| Rate for Payer: Three Rivers Provider Network All |
$237.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$278.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$79.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$294.81
|
| Rate for Payer: Zelis Auto |
$126.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$158.50
|
|
|
IMPLT INTRODUCER SET 7FR CHECK-FLO
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$71.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$165.00
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$242.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$68.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$137.50
|
|
|
IMPLT INTRODUCER SET 7FR CHECK-FLO
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$220.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
|
|
IMPLT INTRODUCER SILOUETTE PEEL-AWAY
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.25 |
| Max. Negotiated Rate |
$491.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: First Health Commercial |
$465.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$465.30
|
| Rate for Payer: GEHA Commercial |
$413.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$465.30
|
| Rate for Payer: Humana ChoiceCare |
$134.42
|
| Rate for Payer: Multiplan All |
$470.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$310.20
|
| Rate for Payer: OMNI Networks Commercial |
$361.90
|
| Rate for Payer: One Health Plan PPO/POS |
$465.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$491.15
|
| Rate for Payer: Three Rivers Provider Network All |
$387.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$454.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$129.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$480.81
|
| Rate for Payer: Zelis Auto |
$206.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$258.50
|
|
|
IMPLT INTRODUCER SILOUETTE PEEL-AWAY
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.25 |
| Max. Negotiated Rate |
$491.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: First Health Commercial |
$465.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$465.30
|
| Rate for Payer: GEHA Commercial |
$413.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$465.30
|
| Rate for Payer: Humana ChoiceCare |
$134.42
|
| Rate for Payer: Multiplan All |
$470.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$310.20
|
| Rate for Payer: OMNI Networks Commercial |
$361.90
|
| Rate for Payer: One Health Plan PPO/POS |
$465.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$491.15
|
| Rate for Payer: Three Rivers Provider Network All |
$387.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$454.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$129.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$480.81
|
| Rate for Payer: Zelis Auto |
$206.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$258.50
|
|
|
IMPLT INTRODUCER SILOUETTE PEEL-AWAY
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.80 |
| Max. Negotiated Rate |
$491.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$413.60
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: First Health Commercial |
$465.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$465.30
|
| Rate for Payer: GEHA Commercial |
$361.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$465.30
|
| Rate for Payer: Multiplan All |
$470.47
|
| Rate for Payer: OMNI Networks Commercial |
$361.90
|
| Rate for Payer: One Health Plan PPO/POS |
$465.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$491.15
|
| Rate for Payer: Three Rivers Provider Network All |
$387.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$480.81
|
| Rate for Payer: Zelis Auto |
$206.80
|
|
|
IMPLT INTRODUCER SILOUETTE PEEL-AWAY
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.80 |
| Max. Negotiated Rate |
$491.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$413.60
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: First Health Commercial |
$465.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$465.30
|
| Rate for Payer: GEHA Commercial |
$361.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$465.30
|
| Rate for Payer: Multiplan All |
$470.47
|
| Rate for Payer: OMNI Networks Commercial |
$361.90
|
| Rate for Payer: One Health Plan PPO/POS |
$465.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$491.15
|
| Rate for Payer: Three Rivers Provider Network All |
$387.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$480.81
|
| Rate for Payer: Zelis Auto |
$206.80
|
|
|
IMPLT INTRODUCER SILOUETTE PEEL-AWAY
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.25 |
| Max. Negotiated Rate |
$491.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: First Health Commercial |
$465.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$465.30
|
| Rate for Payer: GEHA Commercial |
$413.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$465.30
|
| Rate for Payer: Humana ChoiceCare |
$134.42
|
| Rate for Payer: Multiplan All |
$470.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$310.20
|
| Rate for Payer: OMNI Networks Commercial |
$361.90
|
| Rate for Payer: One Health Plan PPO/POS |
$465.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$491.15
|
| Rate for Payer: Three Rivers Provider Network All |
$387.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$454.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$129.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$480.81
|
| Rate for Payer: Zelis Auto |
$206.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$258.50
|
|
|
IMPLT INTRODUCER SILOUETTE PEEL-AWAY
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.80 |
| Max. Negotiated Rate |
$491.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$413.60
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: First Health Commercial |
$465.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$465.30
|
| Rate for Payer: GEHA Commercial |
$361.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$465.30
|
| Rate for Payer: Multiplan All |
$470.47
|
| Rate for Payer: OMNI Networks Commercial |
$361.90
|
| Rate for Payer: One Health Plan PPO/POS |
$465.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$491.15
|
| Rate for Payer: Three Rivers Provider Network All |
$387.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$480.81
|
| Rate for Payer: Zelis Auto |
$206.80
|
|
|
IMPLT INTRODUCER SS SYSTEM 7FR
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.25 |
| Max. Negotiated Rate |
$472.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cigna Commercial |
$422.45
|
| Rate for Payer: First Health Commercial |
$447.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$447.30
|
| Rate for Payer: GEHA Commercial |
$397.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$447.30
|
| Rate for Payer: Humana ChoiceCare |
$129.22
|
| Rate for Payer: Multiplan All |
$452.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$298.20
|
| Rate for Payer: OMNI Networks Commercial |
$347.90
|
| Rate for Payer: One Health Plan PPO/POS |
$447.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$472.15
|
| Rate for Payer: Three Rivers Provider Network All |
$372.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$437.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$462.21
|
| Rate for Payer: Zelis Auto |
$198.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$248.50
|
|
|
IMPLT INTRODUCER SS SYSTEM 7FR
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$472.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$397.60
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cigna Commercial |
$422.45
|
| Rate for Payer: First Health Commercial |
$447.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$447.30
|
| Rate for Payer: GEHA Commercial |
$347.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$447.30
|
| Rate for Payer: Multiplan All |
$452.27
|
| Rate for Payer: OMNI Networks Commercial |
$347.90
|
| Rate for Payer: One Health Plan PPO/POS |
$447.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$472.15
|
| Rate for Payer: Three Rivers Provider Network All |
$372.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$462.21
|
| Rate for Payer: Zelis Auto |
$198.80
|
|
