|
IMPLT WIRE GUIDE .045MM X 6IN
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$637.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Humana ChoiceCare |
$207.22
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$478.20
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$701.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$199.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: Zelis Auto |
$318.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$398.50
|
|
|
IMPLT WIRE GUIDE 1.25MM W/QUICK CONN
|
Facility
|
OP
|
$2,445.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.25 |
| Max. Negotiated Rate |
$2,322.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cigna Commercial |
$2,078.25
|
| Rate for Payer: First Health Commercial |
$2,200.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,200.50
|
| Rate for Payer: GEHA Commercial |
$1,956.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,200.50
|
| Rate for Payer: Humana ChoiceCare |
$635.70
|
| Rate for Payer: Multiplan All |
$2,224.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,467.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,711.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,200.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,322.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,833.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,151.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$611.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,273.85
|
| Rate for Payer: Zelis Auto |
$978.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,222.50
|
|
|
IMPLT WIRE GUIDE 1.25MM W/QUICK CONN
|
Facility
|
IP
|
$2,445.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.00 |
| Max. Negotiated Rate |
$2,322.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cigna Commercial |
$2,078.25
|
| Rate for Payer: First Health Commercial |
$2,200.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,200.50
|
| Rate for Payer: GEHA Commercial |
$1,711.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,200.50
|
| Rate for Payer: Multiplan All |
$2,224.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,711.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,200.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,322.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,833.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,273.85
|
| Rate for Payer: Zelis Auto |
$978.00
|
|
|
IMPLT WIRE GUIDE 2.0MM
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$433.50
|
| Rate for Payer: First Health Commercial |
$459.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.00
|
| Rate for Payer: GEHA Commercial |
$408.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.00
|
| Rate for Payer: Humana ChoiceCare |
$132.60
|
| Rate for Payer: Multiplan All |
$464.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$306.00
|
| Rate for Payer: OMNI Networks Commercial |
$357.00
|
| Rate for Payer: One Health Plan PPO/POS |
$459.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$484.50
|
| Rate for Payer: Three Rivers Provider Network All |
$382.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$448.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$474.30
|
| Rate for Payer: Zelis Auto |
$204.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$255.00
|
|
|
IMPLT WIRE GUIDE 2.0MM
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$408.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$433.50
|
| Rate for Payer: First Health Commercial |
$459.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.00
|
| Rate for Payer: GEHA Commercial |
$357.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.00
|
| Rate for Payer: Multiplan All |
$464.10
|
| Rate for Payer: OMNI Networks Commercial |
$357.00
|
| Rate for Payer: One Health Plan PPO/POS |
$459.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$484.50
|
| Rate for Payer: Three Rivers Provider Network All |
$382.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$474.30
|
| Rate for Payer: Zelis Auto |
$204.00
|
|
|
IMPLT WIRE GUIDE 2X200MM NONTHREAD
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7003085
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$348.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$261.60
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$383.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$109.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$218.00
|
|
|
IMPLT WIRE GUIDE 2X200MM NONTHREAD
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7003085
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$348.80
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$305.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
|
|
IMPLT WIRE GUIDE 3.2X300MM THREADED
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$724.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$457.80
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cigna Commercial |
$648.55
|
| Rate for Payer: First Health Commercial |
$686.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$686.70
|
| Rate for Payer: GEHA Commercial |
$610.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$686.70
|
| Rate for Payer: Humana ChoiceCare |
$198.38
|
| Rate for Payer: Multiplan All |
$694.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$457.80
|
| Rate for Payer: OMNI Networks Commercial |
$534.10
|
| Rate for Payer: One Health Plan PPO/POS |
$686.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$724.85
|
| Rate for Payer: Three Rivers Provider Network All |
$572.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$671.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$190.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$709.59
|
| Rate for Payer: Zelis Auto |
$305.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$381.50
|
|
|
IMPLT WIRE GUIDE 3.2X300MM THREADED
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.20 |
| Max. Negotiated Rate |
$724.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$610.40
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cigna Commercial |
$648.55
|
| Rate for Payer: First Health Commercial |
$686.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$686.70
|
| Rate for Payer: GEHA Commercial |
$534.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$686.70
|
| Rate for Payer: Multiplan All |
$694.33
|
| Rate for Payer: OMNI Networks Commercial |
$534.10
|
| Rate for Payer: One Health Plan PPO/POS |
$686.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$724.85
|
| Rate for Payer: Three Rivers Provider Network All |
$572.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$709.59
|
| Rate for Payer: Zelis Auto |
$305.20
|
|
|
IMPLT WIRE GUIDE AMPLATZ G03290
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$148.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$157.25
|
| Rate for Payer: First Health Commercial |
$166.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$166.50
|
| Rate for Payer: GEHA Commercial |
$129.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$166.50
|
| Rate for Payer: Multiplan All |
$168.35
|
| Rate for Payer: OMNI Networks Commercial |
$129.50
|
| Rate for Payer: One Health Plan PPO/POS |
$166.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$175.75
|
| Rate for Payer: Three Rivers Provider Network All |
$138.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.05
|
| Rate for Payer: Zelis Auto |
$74.00
|
|
|
IMPLT WIRE GUIDE AMPLATZ G03290
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.25 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$157.25
|
| Rate for Payer: First Health Commercial |
$166.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$166.50
|
| Rate for Payer: GEHA Commercial |
$148.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$166.50
|
| Rate for Payer: Humana ChoiceCare |
$48.10
|
| Rate for Payer: Multiplan All |
$168.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$111.00
|
| Rate for Payer: OMNI Networks Commercial |
$129.50
|
| Rate for Payer: One Health Plan PPO/POS |
$166.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$175.75
|
| Rate for Payer: Three Rivers Provider Network All |
$138.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$162.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.05
|
| Rate for Payer: Zelis Auto |
$74.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$92.50
|
|
|
IMPLT WIRE GUIDE AMPLATZ G04048
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.75 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$370.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| Rate for Payer: Humana ChoiceCare |
$120.38
|
| Rate for Payer: Multiplan All |
$421.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$277.80
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$407.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.50
|
|
|
IMPLT WIRE GUIDE AMPLATZ G04048
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$370.40
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$324.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| Rate for Payer: Multiplan All |
$421.33
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: Zelis Auto |
$185.20
|
|
|
IMPLT WIRE GUIDE AMPLATZ G09956
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$178.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$57.98
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$133.80
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: Zelis Auto |
$89.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$111.50
|
|
|
IMPLT WIRE GUIDE AMPLATZ G09956
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$178.40
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$156.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: Zelis Auto |
$89.20
|
|
|
IMPLT WIRE GUIDE AMPLATZ G10168
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$134.30
|
| Rate for Payer: First Health Commercial |
$142.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$142.20
|
| Rate for Payer: GEHA Commercial |
$126.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$142.20
|
| Rate for Payer: Humana ChoiceCare |
$41.08
|
| Rate for Payer: Multiplan All |
$143.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$94.80
|
| Rate for Payer: OMNI Networks Commercial |
$110.60
|
| Rate for Payer: One Health Plan PPO/POS |
$142.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$150.10
|
| Rate for Payer: Three Rivers Provider Network All |
$118.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$139.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.94
|
| Rate for Payer: Zelis Auto |
$63.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$79.00
|
|
|
IMPLT WIRE GUIDE AMPLATZ G10168
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$126.40
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$134.30
|
| Rate for Payer: First Health Commercial |
$142.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$142.20
|
| Rate for Payer: GEHA Commercial |
$110.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$142.20
|
| Rate for Payer: Multiplan All |
$143.78
|
| Rate for Payer: OMNI Networks Commercial |
$110.60
|
| Rate for Payer: One Health Plan PPO/POS |
$142.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$150.10
|
| Rate for Payer: Three Rivers Provider Network All |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.94
|
| Rate for Payer: Zelis Auto |
$63.20
|
|
|
IMPLT WIRE GUIDE BALL TIP 2.5X800MM
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.25 |
| Max. Negotiated Rate |
$646.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$408.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cigna Commercial |
$578.85
|
| Rate for Payer: First Health Commercial |
$612.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$612.90
|
| Rate for Payer: GEHA Commercial |
$544.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$612.90
|
| Rate for Payer: Humana ChoiceCare |
$177.06
|
| Rate for Payer: Multiplan All |
$619.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$408.60
|
| Rate for Payer: OMNI Networks Commercial |
$476.70
|
| Rate for Payer: One Health Plan PPO/POS |
$612.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$646.95
|
| Rate for Payer: Three Rivers Provider Network All |
$510.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$599.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$170.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$633.33
|
| Rate for Payer: Zelis Auto |
$272.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$340.50
|
|
|
IMPLT WIRE GUIDE BALL TIP 2.5X800MM
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.40 |
| Max. Negotiated Rate |
$646.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.80
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cigna Commercial |
$578.85
|
| Rate for Payer: First Health Commercial |
$612.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$612.90
|
| Rate for Payer: GEHA Commercial |
$476.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$612.90
|
| Rate for Payer: Multiplan All |
$619.71
|
| Rate for Payer: OMNI Networks Commercial |
$476.70
|
| Rate for Payer: One Health Plan PPO/POS |
$612.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$646.95
|
| Rate for Payer: Three Rivers Provider Network All |
$510.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$633.33
|
| Rate for Payer: Zelis Auto |
$272.40
|
|
|
IMPLT WIRE GUIDE BALL TIPPED 03X1000MM
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001751
|
|
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 WIRE GUIDE BALL TIPPED 03X1000MM
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001751
|
|
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 WIRE GUIDE BALL TIPPED 3X800MM
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.75 |
| Max. Negotiated Rate |
$823.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$736.95
|
| Rate for Payer: First Health Commercial |
$780.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$780.30
|
| Rate for Payer: GEHA Commercial |
$693.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$780.30
|
| Rate for Payer: Humana ChoiceCare |
$225.42
|
| Rate for Payer: Multiplan All |
$788.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$520.20
|
| Rate for Payer: OMNI Networks Commercial |
$606.90
|
| Rate for Payer: One Health Plan PPO/POS |
$780.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$823.65
|
| Rate for Payer: Three Rivers Provider Network All |
$650.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$762.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$216.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$806.31
|
| Rate for Payer: Zelis Auto |
$346.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$433.50
|
|
|
IMPLT WIRE GUIDE BALL TIPPED 3X800MM
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.80 |
| Max. Negotiated Rate |
$823.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$693.60
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$736.95
|
| Rate for Payer: First Health Commercial |
$780.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$780.30
|
| Rate for Payer: GEHA Commercial |
$606.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$780.30
|
| Rate for Payer: Multiplan All |
$788.97
|
| Rate for Payer: OMNI Networks Commercial |
$606.90
|
| Rate for Payer: One Health Plan PPO/POS |
$780.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$823.65
|
| Rate for Payer: Three Rivers Provider Network All |
$650.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$806.31
|
| Rate for Payer: Zelis Auto |
$346.80
|
|
|
IMPLT WIRE GUIDE CEREBRAL BENTSON
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001762
|
|
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 WIRE GUIDE CEREBRAL BENTSON
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001762
|
|
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
|
|
