|
IMPLT SCRW LCK CORT 3.5X38MM
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.50 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$875.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Humana ChoiceCare |
$284.44
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$656.40
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$962.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$547.00
|
|
|
IMPLT SCRW PERI-LOC 3.5MMX22MM
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.60 |
| Max. Negotiated Rate |
$854.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$719.20
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cigna Commercial |
$764.15
|
| Rate for Payer: First Health Commercial |
$809.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$809.10
|
| Rate for Payer: GEHA Commercial |
$629.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$809.10
|
| Rate for Payer: Multiplan All |
$818.09
|
| Rate for Payer: OMNI Networks Commercial |
$629.30
|
| Rate for Payer: One Health Plan PPO/POS |
$809.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$854.05
|
| Rate for Payer: Three Rivers Provider Network All |
$674.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$836.07
|
| Rate for Payer: Zelis Auto |
$359.60
|
|
|
IMPLT SCRW PERI-LOC 3.5MMX22MM
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.75 |
| Max. Negotiated Rate |
$854.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cigna Commercial |
$764.15
|
| Rate for Payer: First Health Commercial |
$809.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$809.10
|
| Rate for Payer: GEHA Commercial |
$719.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$809.10
|
| Rate for Payer: Humana ChoiceCare |
$233.74
|
| Rate for Payer: Multiplan All |
$818.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$539.40
|
| Rate for Payer: OMNI Networks Commercial |
$629.30
|
| Rate for Payer: One Health Plan PPO/POS |
$809.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$854.05
|
| Rate for Payer: Three Rivers Provider Network All |
$674.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$791.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$836.07
|
| Rate for Payer: Zelis Auto |
$359.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.50
|
|
|
IMPLT SCR Z 6.5X65 CANN 32MM
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.75 |
| Max. Negotiated Rate |
$1,028.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cigna Commercial |
$920.55
|
| Rate for Payer: First Health Commercial |
$974.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$974.70
|
| Rate for Payer: GEHA Commercial |
$866.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$974.70
|
| Rate for Payer: Humana ChoiceCare |
$281.58
|
| Rate for Payer: Multiplan All |
$985.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$649.80
|
| Rate for Payer: OMNI Networks Commercial |
$758.10
|
| Rate for Payer: One Health Plan PPO/POS |
$974.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,028.85
|
| Rate for Payer: Three Rivers Provider Network All |
$812.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$953.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$270.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,007.19
|
| Rate for Payer: Zelis Auto |
$433.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$541.50
|
|
|
IMPLT SCR Z 6.5X65 CANN 32MM
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.20 |
| Max. Negotiated Rate |
$1,028.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$866.40
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cigna Commercial |
$920.55
|
| Rate for Payer: First Health Commercial |
$974.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$974.70
|
| Rate for Payer: GEHA Commercial |
$758.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$974.70
|
| Rate for Payer: Multiplan All |
$985.53
|
| Rate for Payer: OMNI Networks Commercial |
$758.10
|
| Rate for Payer: One Health Plan PPO/POS |
$974.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,028.85
|
| Rate for Payer: Three Rivers Provider Network All |
$812.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,007.19
|
| Rate for Payer: Zelis Auto |
$433.20
|
|
|
IMPLT SC SN PERI 3.5X10
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001242
|
|
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 SC SN PERI 3.5X10
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001242
|
|
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 SEPRAFILM
|
Facility
|
IP
|
$1,435.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$1,363.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,148.00
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$1,219.75
|
| Rate for Payer: First Health Commercial |
$1,291.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,291.50
|
| Rate for Payer: GEHA Commercial |
$1,004.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,291.50
|
| Rate for Payer: Multiplan All |
$1,305.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,004.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,291.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,363.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,076.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,334.55
|
| Rate for Payer: Zelis Auto |
$574.00
|
|
|
IMPLT SEPRAFILM
|
Facility
|
OP
|
$1,435.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.75 |
| Max. Negotiated Rate |
$1,363.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$861.00
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$1,219.75
|
| Rate for Payer: First Health Commercial |
$1,291.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,291.50
|
| Rate for Payer: GEHA Commercial |
$1,148.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,291.50
|
| Rate for Payer: Humana ChoiceCare |
$373.10
|
| Rate for Payer: Multiplan All |
$1,305.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$861.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,004.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,291.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,363.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,076.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,262.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$358.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,334.55
|
| Rate for Payer: Zelis Auto |
$574.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$717.50
|
|
|
IMPLT SET 2.0 SS BEADED CABLE
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$380.00 |
| Max. Negotiated Rate |
$1,444.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$912.00
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cigna Commercial |
$1,292.00
|
| Rate for Payer: First Health Commercial |
$1,368.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,368.00
|
| Rate for Payer: GEHA Commercial |
$1,216.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,368.00
|
| Rate for Payer: Humana ChoiceCare |
$395.20
|
| Rate for Payer: Multiplan All |
$1,383.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$912.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,064.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,368.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,444.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,140.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,337.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$380.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,413.60
|
| Rate for Payer: Zelis Auto |
$608.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.00
|
|
|
IMPLT SET 2.0 SS BEADED CABLE
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.00 |
| Max. Negotiated Rate |
$1,444.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,216.00
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cigna Commercial |
$1,292.00
|
| Rate for Payer: First Health Commercial |
$1,368.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,368.00
|
| Rate for Payer: GEHA Commercial |
$1,064.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,368.00
|
| Rate for Payer: Multiplan All |
$1,383.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,064.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,368.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,444.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,140.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,413.60
|
| Rate for Payer: Zelis Auto |
$608.00
|
|
|
IMPLT SET CABLE SLEEVE MILLES DALL 2.0
|
Facility
|
IP
|
$1,409.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.60 |
| Max. Negotiated Rate |
$1,338.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,127.20
|
| Rate for Payer: Cash Price |
$845.40
|
| Rate for Payer: Cash Price |
$845.40
|
| Rate for Payer: Cigna Commercial |
$1,197.65
|
| Rate for Payer: First Health Commercial |
$1,268.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,268.10
|
| Rate for Payer: GEHA Commercial |
$986.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,268.10
|
| Rate for Payer: Multiplan All |
$1,282.19
|
| Rate for Payer: OMNI Networks Commercial |
$986.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,268.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,338.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,056.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,310.37
|
| Rate for Payer: Zelis Auto |
$563.60
|
|
|
IMPLT SET CABLE SLEEVE MILLES DALL 2.0
|
Facility
|
OP
|
$1,409.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.25 |
| Max. Negotiated Rate |
$1,338.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$845.40
|
| Rate for Payer: Cash Price |
$845.40
|
| Rate for Payer: Cash Price |
$845.40
|
| Rate for Payer: Cigna Commercial |
$1,197.65
|
| Rate for Payer: First Health Commercial |
$1,268.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,268.10
|
| Rate for Payer: GEHA Commercial |
$1,127.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,268.10
|
| Rate for Payer: Humana ChoiceCare |
$366.34
|
| Rate for Payer: Multiplan All |
$1,282.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$845.40
|
| Rate for Payer: OMNI Networks Commercial |
$986.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,268.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,338.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,056.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,239.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$352.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,310.37
|
| Rate for Payer: Zelis Auto |
$563.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$704.50
|
|
|
IMPLT SET INTRODUCER G43870
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$57.80
|
| Rate for Payer: First Health Commercial |
$61.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$61.20
|
| Rate for Payer: GEHA Commercial |
$54.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$61.20
|
| Rate for Payer: Humana ChoiceCare |
$17.68
|
| Rate for Payer: Multiplan All |
$61.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.80
|
| Rate for Payer: OMNI Networks Commercial |
$47.60
|
| Rate for Payer: One Health Plan PPO/POS |
$61.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$64.60
|
| Rate for Payer: Three Rivers Provider Network All |
$51.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$59.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$63.24
|
| Rate for Payer: Zelis Auto |
$27.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$34.00
|
|
|
IMPLT SET INTRODUCER G43870
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$57.80
|
| Rate for Payer: First Health Commercial |
$61.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$61.20
|
| Rate for Payer: GEHA Commercial |
$47.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$61.20
|
| Rate for Payer: Multiplan All |
$61.88
|
| Rate for Payer: OMNI Networks Commercial |
$47.60
|
| Rate for Payer: One Health Plan PPO/POS |
$61.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$64.60
|
| Rate for Payer: Three Rivers Provider Network All |
$51.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$63.24
|
| Rate for Payer: Zelis Auto |
$27.20
|
|
|
IMPLT SET INTRODUCER G47942
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$212.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$225.25
|
| Rate for Payer: First Health Commercial |
$238.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.50
|
| Rate for Payer: GEHA Commercial |
$185.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.50
|
| Rate for Payer: Multiplan All |
$241.15
|
| Rate for Payer: OMNI Networks Commercial |
$185.50
|
| Rate for Payer: One Health Plan PPO/POS |
$238.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.75
|
| Rate for Payer: Three Rivers Provider Network All |
$198.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.45
|
| Rate for Payer: Zelis Auto |
$106.00
|
|
|
IMPLT SET INTRODUCER G47942
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$225.25
|
| Rate for Payer: First Health Commercial |
$238.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.50
|
| Rate for Payer: GEHA Commercial |
$212.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.50
|
| Rate for Payer: Humana ChoiceCare |
$68.90
|
| Rate for Payer: Multiplan All |
$241.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$159.00
|
| Rate for Payer: OMNI Networks Commercial |
$185.50
|
| Rate for Payer: One Health Plan PPO/POS |
$238.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.75
|
| Rate for Payer: Three Rivers Provider Network All |
$198.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$233.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.45
|
| Rate for Payer: Zelis Auto |
$106.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.50
|
|
|
IMPLT SET INTRODUCER G47952
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$220.80
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$193.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: Zelis Auto |
$110.40
|
|
|
IMPLT SET INTRODUCER G47952
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$220.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Humana ChoiceCare |
$71.76
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$165.60
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$242.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: Zelis Auto |
$110.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$138.00
|
|
|
IMPLT SHEATH INTODUCER FLEXOR G08681
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: First Health Commercial |
$374.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$374.40
|
| Rate for Payer: GEHA Commercial |
$332.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$374.40
|
| Rate for Payer: Humana ChoiceCare |
$108.16
|
| Rate for Payer: Multiplan All |
$378.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$249.60
|
| Rate for Payer: OMNI Networks Commercial |
$291.20
|
| Rate for Payer: One Health Plan PPO/POS |
$374.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$395.20
|
| Rate for Payer: Three Rivers Provider Network All |
$312.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$366.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$104.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$386.88
|
| Rate for Payer: Zelis Auto |
$166.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$208.00
|
|
|
IMPLT SHEATH INTODUCER FLEXOR G08681
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$332.80
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: First Health Commercial |
$374.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$374.40
|
| Rate for Payer: GEHA Commercial |
$291.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$374.40
|
| Rate for Payer: Multiplan All |
$378.56
|
| Rate for Payer: OMNI Networks Commercial |
$291.20
|
| Rate for Payer: One Health Plan PPO/POS |
$374.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$395.20
|
| Rate for Payer: Three Rivers Provider Network All |
$312.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$386.88
|
| Rate for Payer: Zelis Auto |
$166.40
|
|
|
IMPLT SHEATH INTRODUCER 18FR
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.25 |
| Max. Negotiated Rate |
$1,456.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$919.80
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,303.05
|
| Rate for Payer: First Health Commercial |
$1,379.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,379.70
|
| Rate for Payer: GEHA Commercial |
$1,226.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,379.70
|
| Rate for Payer: Humana ChoiceCare |
$398.58
|
| Rate for Payer: Multiplan All |
$1,395.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$919.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,073.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,379.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,456.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,149.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,349.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$383.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,425.69
|
| Rate for Payer: Zelis Auto |
$613.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$766.50
|
|
|
IMPLT SHEATH INTRODUCER 18FR
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.20 |
| Max. Negotiated Rate |
$1,456.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,226.40
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,303.05
|
| Rate for Payer: First Health Commercial |
$1,379.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,379.70
|
| Rate for Payer: GEHA Commercial |
$1,073.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,379.70
|
| Rate for Payer: Multiplan All |
$1,395.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,073.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,379.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,456.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,149.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,425.69
|
| Rate for Payer: Zelis Auto |
$613.20
|
|
|
IMPLT SHEATH INTRODUCER 18FR VAD5TIP
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.75 |
| Max. Negotiated Rate |
$390.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$349.35
|
| Rate for Payer: First Health Commercial |
$369.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$369.90
|
| Rate for Payer: GEHA Commercial |
$328.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$369.90
|
| Rate for Payer: Humana ChoiceCare |
$106.86
|
| Rate for Payer: Multiplan All |
$374.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$246.60
|
| Rate for Payer: OMNI Networks Commercial |
$287.70
|
| Rate for Payer: One Health Plan PPO/POS |
$369.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$390.45
|
| Rate for Payer: Three Rivers Provider Network All |
$308.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$361.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$382.23
|
| Rate for Payer: Zelis Auto |
$164.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$205.50
|
|
|
IMPLT SHEATH INTRODUCER 18FR VAD5TIP
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$390.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$328.80
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$349.35
|
| Rate for Payer: First Health Commercial |
$369.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$369.90
|
| Rate for Payer: GEHA Commercial |
$287.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$369.90
|
| Rate for Payer: Multiplan All |
$374.01
|
| Rate for Payer: OMNI Networks Commercial |
$287.70
|
| Rate for Payer: One Health Plan PPO/POS |
$369.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$390.45
|
| Rate for Payer: Three Rivers Provider Network All |
$308.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$382.23
|
| Rate for Payer: Zelis Auto |
$164.40
|
|
