|
IMPLT WIRE GUIDE COE MANDRIL 60CM
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$221.00
|
| Rate for Payer: First Health Commercial |
$234.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.00
|
| Rate for Payer: GEHA Commercial |
$208.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.00
|
| Rate for Payer: Humana ChoiceCare |
$67.60
|
| Rate for Payer: Multiplan All |
$236.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$156.00
|
| Rate for Payer: OMNI Networks Commercial |
$182.00
|
| Rate for Payer: One Health Plan PPO/POS |
$234.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.00
|
| Rate for Payer: Three Rivers Provider Network All |
$195.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$228.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.80
|
| Rate for Payer: Zelis Auto |
$104.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$130.00
|
|
|
IMPLT WIRE GUIDE COE MANDRIL 60CM
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$208.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$221.00
|
| Rate for Payer: First Health Commercial |
$234.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.00
|
| Rate for Payer: GEHA Commercial |
$182.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.00
|
| Rate for Payer: Multiplan All |
$236.60
|
| Rate for Payer: OMNI Networks Commercial |
$182.00
|
| Rate for Payer: One Health Plan PPO/POS |
$234.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.00
|
| Rate for Payer: Three Rivers Provider Network All |
$195.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.80
|
| Rate for Payer: Zelis Auto |
$104.00
|
|
|
IMPLT WIRE GUIDE CORE FIXED
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$64.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$21.06
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.60
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$71.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$40.50
|
|
|
IMPLT WIRE GUIDE CORE FIXED
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$107.20
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
|
|
IMPLT WIRE GUIDE CORE FIXED
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$64.80
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$56.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
|
|
IMPLT WIRE GUIDE CORE FIXED
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$107.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Humana ChoiceCare |
$34.84
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$80.40
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$117.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.00
|
|
|
IMPLT WIRE GUIDE FIXED CORE 50CM
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
|
|
IMPLT WIRE GUIDE FIXED CORE 50CM
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.40
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
|
|
IMPLT WIRE GUIDE HYDROPHILIC HI-WIRE
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$228.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$256.50
|
| Rate for Payer: GEHA Commercial |
$199.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$256.50
|
| Rate for Payer: Multiplan All |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$199.50
|
| Rate for Payer: One Health Plan PPO/POS |
$256.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$270.75
|
| Rate for Payer: Three Rivers Provider Network All |
$213.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$265.05
|
| Rate for Payer: Zelis Auto |
$114.00
|
|
|
IMPLT WIRE GUIDE HYDROPHILIC HI-WIRE
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$256.50
|
| Rate for Payer: GEHA Commercial |
$228.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$256.50
|
| Rate for Payer: Humana ChoiceCare |
$74.10
|
| Rate for Payer: Multiplan All |
$259.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.00
|
| Rate for Payer: OMNI Networks Commercial |
$199.50
|
| Rate for Payer: One Health Plan PPO/POS |
$256.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$270.75
|
| Rate for Payer: Three Rivers Provider Network All |
$213.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$250.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$265.05
|
| Rate for Payer: Zelis Auto |
$114.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.50
|
|
|
IMPLT WIRE GUIDE HYDROPHILIC HI-WIRE
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$256.50
|
| Rate for Payer: GEHA Commercial |
$228.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$256.50
|
| Rate for Payer: Humana ChoiceCare |
$74.10
|
| Rate for Payer: Multiplan All |
$259.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.00
|
| Rate for Payer: OMNI Networks Commercial |
$199.50
|
| Rate for Payer: One Health Plan PPO/POS |
$256.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$270.75
|
| Rate for Payer: Three Rivers Provider Network All |
$213.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$250.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$265.05
|
| Rate for Payer: Zelis Auto |
$114.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.50
|
|
|
IMPLT WIRE GUIDE HYDROPHILIC HI-WIRE
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$228.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$256.50
|
| Rate for Payer: GEHA Commercial |
$199.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$256.50
|
| Rate for Payer: Multiplan All |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$199.50
|
| Rate for Payer: One Health Plan PPO/POS |
$256.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$270.75
|
| Rate for Payer: Three Rivers Provider Network All |
$213.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$265.05
|
| Rate for Payer: Zelis Auto |
$114.00
|
|
|
IMPLT WIRE GUIDE HYDROPHILIC HI-WIRE
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$256.50
|
| Rate for Payer: GEHA Commercial |
$228.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$256.50
|
| Rate for Payer: Humana ChoiceCare |
$74.10
|
| Rate for Payer: Multiplan All |
$259.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.00
|
| Rate for Payer: OMNI Networks Commercial |
$199.50
|
| Rate for Payer: One Health Plan PPO/POS |
$256.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$270.75
|
| Rate for Payer: Three Rivers Provider Network All |
$213.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$250.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$265.05
|
| Rate for Payer: Zelis Auto |
$114.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.50
|
|
|
IMPLT WIRE GUIDE HYDROPHILIC HI-WIRE
|
Facility
|
IP
|
$3,730.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.00 |
| Max. Negotiated Rate |
$3,543.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,984.00
|
| Rate for Payer: Cash Price |
$2,238.00
|
| Rate for Payer: Cash Price |
$2,238.00
|
| Rate for Payer: Cigna Commercial |
$3,170.50
|
| Rate for Payer: First Health Commercial |
$3,357.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,357.00
|
| Rate for Payer: GEHA Commercial |
$2,611.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,357.00
|
| Rate for Payer: Multiplan All |
$3,394.30
|
| Rate for Payer: OMNI Networks Commercial |
$2,611.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,357.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,543.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,797.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,468.90
|
| Rate for Payer: Zelis Auto |
$1,492.00
|
|
|
IMPLT WIRE GUIDE HYDROPHILIC HI-WIRE
|
Facility
|
OP
|
$3,730.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.50 |
| Max. Negotiated Rate |
$3,543.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,238.00
|
| Rate for Payer: Cash Price |
$2,238.00
|
| Rate for Payer: Cash Price |
$2,238.00
|
| Rate for Payer: Cigna Commercial |
$3,170.50
|
| Rate for Payer: First Health Commercial |
$3,357.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,357.00
|
| Rate for Payer: GEHA Commercial |
$2,984.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,357.00
|
| Rate for Payer: Humana ChoiceCare |
$969.80
|
| Rate for Payer: Multiplan All |
$3,394.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,238.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,611.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,357.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,543.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,797.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,282.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$932.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,468.90
|
| Rate for Payer: Zelis Auto |
$1,492.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,865.00
|
|
|
IMPLT WIRE GUIDE HYDROPHILIC HI-WIRE
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$228.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$256.50
|
| Rate for Payer: GEHA Commercial |
$199.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$256.50
|
| Rate for Payer: Multiplan All |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$199.50
|
| Rate for Payer: One Health Plan PPO/POS |
$256.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$270.75
|
| Rate for Payer: Three Rivers Provider Network All |
$213.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$265.05
|
| Rate for Payer: Zelis Auto |
$114.00
|
|
|
IMPLT WIRE GUIDE J-CURVE FIXED CORE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$92.80
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$98.60
|
| Rate for Payer: First Health Commercial |
$104.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$104.40
|
| Rate for Payer: GEHA Commercial |
$81.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$104.40
|
| Rate for Payer: Multiplan All |
$105.56
|
| Rate for Payer: OMNI Networks Commercial |
$81.20
|
| Rate for Payer: One Health Plan PPO/POS |
$104.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$110.20
|
| Rate for Payer: Three Rivers Provider Network All |
$87.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$107.88
|
| Rate for Payer: Zelis Auto |
$46.40
|
|
|
IMPLT WIRE GUIDE J-CURVE FIXED CORE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$98.60
|
| Rate for Payer: First Health Commercial |
$104.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$104.40
|
| Rate for Payer: GEHA Commercial |
$92.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$104.40
|
| Rate for Payer: Humana ChoiceCare |
$30.16
|
| Rate for Payer: Multiplan All |
$105.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$69.60
|
| Rate for Payer: OMNI Networks Commercial |
$81.20
|
| Rate for Payer: One Health Plan PPO/POS |
$104.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$110.20
|
| Rate for Payer: Three Rivers Provider Network All |
$87.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$102.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$107.88
|
| Rate for Payer: Zelis Auto |
$46.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$58.00
|
|
|
IMPLT WIRE GUIDE NITINOL
|
Facility
|
IP
|
$903.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$361.20 |
| Max. Negotiated Rate |
$857.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$767.55
|
| Rate for Payer: First Health Commercial |
$812.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$812.70
|
| Rate for Payer: GEHA Commercial |
$632.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$812.70
|
| Rate for Payer: Multiplan All |
$821.73
|
| Rate for Payer: OMNI Networks Commercial |
$632.10
|
| Rate for Payer: One Health Plan PPO/POS |
$812.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$857.85
|
| Rate for Payer: Three Rivers Provider Network All |
$677.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$839.79
|
| Rate for Payer: Zelis Auto |
$361.20
|
|
|
IMPLT WIRE GUIDE NITINOL
|
Facility
|
OP
|
$903.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$857.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$767.55
|
| Rate for Payer: First Health Commercial |
$812.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$812.70
|
| Rate for Payer: GEHA Commercial |
$722.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$812.70
|
| Rate for Payer: Humana ChoiceCare |
$234.78
|
| Rate for Payer: Multiplan All |
$821.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$541.80
|
| Rate for Payer: OMNI Networks Commercial |
$632.10
|
| Rate for Payer: One Health Plan PPO/POS |
$812.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$857.85
|
| Rate for Payer: Three Rivers Provider Network All |
$677.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$794.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$225.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$839.79
|
| Rate for Payer: Zelis Auto |
$361.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$451.50
|
|
|
IMPLT WIRE GUIDE NITOL .038
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.25 |
| Max. Negotiated Rate |
$1,053.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$665.40
|
| Rate for Payer: Cash Price |
$665.40
|
| Rate for Payer: Cash Price |
$665.40
|
| Rate for Payer: Cigna Commercial |
$942.65
|
| Rate for Payer: First Health Commercial |
$998.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$998.10
|
| Rate for Payer: GEHA Commercial |
$887.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$998.10
|
| Rate for Payer: Humana ChoiceCare |
$288.34
|
| Rate for Payer: Multiplan All |
$1,009.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$665.40
|
| Rate for Payer: OMNI Networks Commercial |
$776.30
|
| Rate for Payer: One Health Plan PPO/POS |
$998.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,053.55
|
| Rate for Payer: Three Rivers Provider Network All |
$831.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$975.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$277.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,031.37
|
| Rate for Payer: Zelis Auto |
$443.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$554.50
|
|
|
IMPLT WIRE GUIDE NITOL .038
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$443.60 |
| Max. Negotiated Rate |
$1,053.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$887.20
|
| Rate for Payer: Cash Price |
$665.40
|
| Rate for Payer: Cash Price |
$665.40
|
| Rate for Payer: Cigna Commercial |
$942.65
|
| Rate for Payer: First Health Commercial |
$998.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$998.10
|
| Rate for Payer: GEHA Commercial |
$776.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$998.10
|
| Rate for Payer: Multiplan All |
$1,009.19
|
| Rate for Payer: OMNI Networks Commercial |
$776.30
|
| Rate for Payer: One Health Plan PPO/POS |
$998.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,053.55
|
| Rate for Payer: Three Rivers Provider Network All |
$831.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,031.37
|
| Rate for Payer: Zelis Auto |
$443.60
|
|
|
IMPLT WIRE GUIDE PC ROADRUNNER
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.75 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$199.75
|
| Rate for Payer: First Health Commercial |
$211.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$211.50
|
| Rate for Payer: GEHA Commercial |
$188.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$211.50
|
| Rate for Payer: Humana ChoiceCare |
$61.10
|
| Rate for Payer: Multiplan All |
$213.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$141.00
|
| Rate for Payer: OMNI Networks Commercial |
$164.50
|
| Rate for Payer: One Health Plan PPO/POS |
$211.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$223.25
|
| Rate for Payer: Three Rivers Provider Network All |
$176.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$206.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$58.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$218.55
|
| Rate for Payer: Zelis Auto |
$94.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$117.50
|
|
|
IMPLT WIRE GUIDE PC ROADRUNNER
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$188.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$199.75
|
| Rate for Payer: First Health Commercial |
$211.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$211.50
|
| Rate for Payer: GEHA Commercial |
$164.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$211.50
|
| Rate for Payer: Multiplan All |
$213.85
|
| Rate for Payer: OMNI Networks Commercial |
$164.50
|
| Rate for Payer: One Health Plan PPO/POS |
$211.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$223.25
|
| Rate for Payer: Three Rivers Provider Network All |
$176.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$218.55
|
| Rate for Payer: Zelis Auto |
$94.00
|
|
|
IMPLT WIRE GUIDE SMOOTH TIP 3X800MM
|
Facility
|
OP
|
$961.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.25 |
| Max. Negotiated Rate |
$912.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$576.60
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$816.85
|
| Rate for Payer: First Health Commercial |
$864.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.90
|
| Rate for Payer: GEHA Commercial |
$768.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.90
|
| Rate for Payer: Humana ChoiceCare |
$249.86
|
| Rate for Payer: Multiplan All |
$874.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.60
|
| Rate for Payer: OMNI Networks Commercial |
$672.70
|
| Rate for Payer: One Health Plan PPO/POS |
$864.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.95
|
| Rate for Payer: Three Rivers Provider Network All |
$720.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$845.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$240.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$893.73
|
| Rate for Payer: Zelis Auto |
$384.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$480.50
|
|
