|
IMPLANT SPINAL CANAL CATH
|
Facility
|
OP
|
$1,823.00
|
|
|
Service Code
|
CPT 62351
|
| Hospital Charge Code |
6162351
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$497.68 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,977.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,093.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,977.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,942.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,093.80
|
| Rate for Payer: Cash Price |
$1,093.80
|
| Rate for Payer: Cigna Commercial |
$1,549.55
|
| Rate for Payer: First Health Commercial |
$1,640.70
|
| Rate for Payer: First Health Workers Compensation |
$703.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,640.70
|
| Rate for Payer: GEHA Commercial |
$1,458.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,640.70
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,023.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,658.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,276.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,640.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,645.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,023.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,731.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,367.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,023.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,695.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$729.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$497.68
|
|
|
IMPLANT SPINAL CANAL CATH
|
Facility
|
IP
|
$1,823.00
|
|
|
Service Code
|
CPT 62351
|
| Hospital Charge Code |
6162351
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$497.68 |
| Max. Negotiated Rate |
$1,731.85 |
| Rate for Payer: Cash Price |
$1,093.80
|
| Rate for Payer: Cigna Commercial |
$1,549.55
|
| Rate for Payer: First Health Commercial |
$1,640.70
|
| Rate for Payer: First Health Workers Compensation |
$703.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,640.70
|
| Rate for Payer: GEHA Commercial |
$1,276.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,640.70
|
| Rate for Payer: Multiplan All |
$1,658.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,276.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,640.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,731.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,367.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,695.39
|
| Rate for Payer: Zelis Auto |
$729.20
|
| Rate for Payer: Zelis Worker's Compensation |
$497.68
|
|
|
IMPLANT SPINAL CANAL CATH
|
Facility
|
OP
|
$832.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
6162350
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.14 |
| Max. Negotiated Rate |
$12,161.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,148.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$499.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,148.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,286.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,080.92
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$707.20
|
| Rate for Payer: First Health Commercial |
$748.80
|
| Rate for Payer: First Health Workers Compensation |
$321.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$748.80
|
| Rate for Payer: GEHA Commercial |
$665.60
|
| Rate for Payer: GEHA Medicare |
$6,080.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$748.80
|
| Rate for Payer: Humana ChoiceCare |
$6,689.01
|
| Rate for Payer: Humana Medicare Advantage |
$6,080.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,215.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,353.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,080.92
|
| Rate for Payer: Multiplan All |
$757.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,337.56
|
| Rate for Payer: OMNI Networks Commercial |
$582.40
|
| Rate for Payer: One Health Plan PPO/POS |
$748.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,871.83
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,353.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,080.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$790.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,161.84
|
| Rate for Payer: Three Rivers Provider Network All |
$624.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,959.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,353.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,080.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$773.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,080.92
|
| Rate for Payer: Zelis Auto |
$332.80
|
| Rate for Payer: Zelis Medicare |
$5,168.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,297.10
|
| Rate for Payer: Zelis Worker's Compensation |
$227.14
|
|
|
IMPLANT SPINE INFUSION PUMP
|
Facility
|
OP
|
$933.00
|
|
|
Service Code
|
CPT 62361
|
| Hospital Charge Code |
6162361
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.71 |
| Max. Negotiated Rate |
$33,564.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20,086.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$559.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20,086.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15,912.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16,782.28
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna Commercial |
$793.05
|
| Rate for Payer: First Health Commercial |
$839.70
|
| Rate for Payer: First Health Workers Compensation |
$360.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$839.70
|
| Rate for Payer: GEHA Commercial |
$746.40
|
| Rate for Payer: GEHA Medicare |
$16,782.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$839.70
|
| Rate for Payer: Humana ChoiceCare |
$18,460.51
|
| Rate for Payer: Humana Medicare Advantage |
$16,782.28
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28,194.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16,236.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16,782.28
|
| Rate for Payer: Multiplan All |
$849.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28,529.88
|
| Rate for Payer: OMNI Networks Commercial |
$653.10
|
| Rate for Payer: One Health Plan PPO/POS |
$839.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$18,746.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16,236.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16,782.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$886.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33,564.56
|
| Rate for Payer: Three Rivers Provider Network All |
$699.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,446.63
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16,236.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,782.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$867.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16,782.28
|
| Rate for Payer: Zelis Auto |
$373.20
|
| Rate for Payer: Zelis Medicare |
$14,264.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,138.74
|
| Rate for Payer: Zelis Worker's Compensation |
$254.71
|
|
|
IMPLANT SPINE INFUSION PUMP
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 62362
|
| Hospital Charge Code |
6162362
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$274.64 |
| Max. Negotiated Rate |
$955.70 |
| Rate for Payer: Cash Price |
$603.60
|
| Rate for Payer: Cigna Commercial |
$855.10
|
| Rate for Payer: First Health Commercial |
$905.40
|
| Rate for Payer: First Health Workers Compensation |
$388.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$905.40
|
| Rate for Payer: GEHA Commercial |
$704.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$905.40
|
| Rate for Payer: Multiplan All |
$915.46
|
| Rate for Payer: OMNI Networks Commercial |
$704.20
|
| Rate for Payer: One Health Plan PPO/POS |
$905.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$955.70
|
| Rate for Payer: Three Rivers Provider Network All |
$754.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$935.58
|
| Rate for Payer: Zelis Auto |
$402.40
|
| Rate for Payer: Zelis Worker's Compensation |
$274.64
|
|
|
IMPLANT SPINE INFUSION PUMP
|
Facility
|
IP
|
$933.00
|
|
|
Service Code
|
CPT 62361
|
| Hospital Charge Code |
6162361
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.71 |
| Max. Negotiated Rate |
$886.35 |
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna Commercial |
$793.05
|
| Rate for Payer: First Health Commercial |
$839.70
|
| Rate for Payer: First Health Workers Compensation |
$360.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$839.70
|
| Rate for Payer: GEHA Commercial |
$653.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$839.70
|
| Rate for Payer: Multiplan All |
$849.03
|
| Rate for Payer: OMNI Networks Commercial |
$653.10
|
| Rate for Payer: One Health Plan PPO/POS |
$839.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$886.35
|
| Rate for Payer: Three Rivers Provider Network All |
$699.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$867.69
|
| Rate for Payer: Zelis Auto |
$373.20
|
| Rate for Payer: Zelis Worker's Compensation |
$254.71
|
|
|
IMPLANT SPINE INFUSION PUMP
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 62362
|
| Hospital Charge Code |
6162362
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$274.64 |
| Max. Negotiated Rate |
$33,564.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20,086.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$603.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20,086.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15,912.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16,782.28
|
| Rate for Payer: Cash Price |
$603.60
|
| Rate for Payer: Cash Price |
$603.60
|
| Rate for Payer: Cigna Commercial |
$855.10
|
| Rate for Payer: First Health Commercial |
$905.40
|
| Rate for Payer: First Health Workers Compensation |
$388.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$905.40
|
| Rate for Payer: GEHA Commercial |
$804.80
|
| Rate for Payer: GEHA Medicare |
$16,782.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$905.40
|
| Rate for Payer: Humana ChoiceCare |
$18,460.51
|
| Rate for Payer: Humana Medicare Advantage |
$16,782.28
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28,194.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16,236.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16,782.28
|
| Rate for Payer: Multiplan All |
$915.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28,529.88
|
| Rate for Payer: OMNI Networks Commercial |
$704.20
|
| Rate for Payer: One Health Plan PPO/POS |
$905.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$18,746.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16,236.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16,782.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$955.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33,564.56
|
| Rate for Payer: Three Rivers Provider Network All |
$754.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,446.63
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16,236.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,782.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$935.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16,782.28
|
| Rate for Payer: Zelis Auto |
$402.40
|
| Rate for Payer: Zelis Medicare |
$14,264.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,138.74
|
| Rate for Payer: Zelis Worker's Compensation |
$274.64
|
|
|
IMPLANT SUBTALAR CONICAL
|
Facility
|
IP
|
$3,660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.00 |
| Max. Negotiated Rate |
$3,477.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,928.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna Commercial |
$3,111.00
|
| Rate for Payer: First Health Commercial |
$3,294.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,294.00
|
| Rate for Payer: GEHA Commercial |
$2,562.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,294.00
|
| Rate for Payer: Multiplan All |
$3,330.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,562.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,294.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,477.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,745.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,403.80
|
| Rate for Payer: Zelis Auto |
$1,464.00
|
|
|
IMPLANT SUBTALAR CONICAL
|
Facility
|
OP
|
$3,660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$3,477.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna Commercial |
$3,111.00
|
| Rate for Payer: First Health Commercial |
$3,294.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,294.00
|
| Rate for Payer: GEHA Commercial |
$2,928.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,294.00
|
| Rate for Payer: Humana ChoiceCare |
$951.60
|
| Rate for Payer: Multiplan All |
$3,330.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,196.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,562.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,294.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,477.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,745.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,220.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$915.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,403.80
|
| Rate for Payer: Zelis Auto |
$1,464.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,830.00
|
|
|
IMPLANT SUBTALAR CONICAL
|
Facility
|
IP
|
$3,660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.00 |
| Max. Negotiated Rate |
$3,477.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,928.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna Commercial |
$3,111.00
|
| Rate for Payer: First Health Commercial |
$3,294.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,294.00
|
| Rate for Payer: GEHA Commercial |
$2,562.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,294.00
|
| Rate for Payer: Multiplan All |
$3,330.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,562.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,294.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,477.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,745.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,403.80
|
| Rate for Payer: Zelis Auto |
$1,464.00
|
|
|
IMPLANT SUBTALAR CONICAL
|
Facility
|
OP
|
$3,660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$3,477.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna Commercial |
$3,111.00
|
| Rate for Payer: First Health Commercial |
$3,294.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,294.00
|
| Rate for Payer: GEHA Commercial |
$2,928.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,294.00
|
| Rate for Payer: Humana ChoiceCare |
$951.60
|
| Rate for Payer: Multiplan All |
$3,330.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,196.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,562.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,294.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,477.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,745.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,220.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$915.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,403.80
|
| Rate for Payer: Zelis Auto |
$1,464.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,830.00
|
|
|
IMPLANT SYSTEM CITRELOCK XPRESS 4 X 10
|
Facility
|
IP
|
$6,266.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.40 |
| Max. Negotiated Rate |
$5,952.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,012.80
|
| Rate for Payer: Cash Price |
$3,759.60
|
| Rate for Payer: Cash Price |
$3,759.60
|
| Rate for Payer: Cigna Commercial |
$5,326.10
|
| Rate for Payer: First Health Commercial |
$5,639.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,639.40
|
| Rate for Payer: GEHA Commercial |
$4,386.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,639.40
|
| Rate for Payer: Multiplan All |
$5,702.06
|
| Rate for Payer: OMNI Networks Commercial |
$4,386.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,639.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,952.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,699.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,827.38
|
| Rate for Payer: Zelis Auto |
$2,506.40
|
|
|
IMPLANT SYSTEM CITRELOCK XPRESS 4 X 10
|
Facility
|
OP
|
$6,266.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,566.50 |
| Max. Negotiated Rate |
$5,952.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,759.60
|
| Rate for Payer: Cash Price |
$3,759.60
|
| Rate for Payer: Cash Price |
$3,759.60
|
| Rate for Payer: Cigna Commercial |
$5,326.10
|
| Rate for Payer: First Health Commercial |
$5,639.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,639.40
|
| Rate for Payer: GEHA Commercial |
$5,012.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,639.40
|
| Rate for Payer: Humana ChoiceCare |
$1,629.16
|
| Rate for Payer: Multiplan All |
$5,702.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,759.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,386.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,639.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,952.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,699.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,514.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,566.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,827.38
|
| Rate for Payer: Zelis Auto |
$2,506.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,133.00
|
|
|
IMPLANT SYSTEM CITRELOCK XPRESS 5 X 10
|
Facility
|
IP
|
$6,266.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.40 |
| Max. Negotiated Rate |
$5,952.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,012.80
|
| Rate for Payer: Cash Price |
$3,759.60
|
| Rate for Payer: Cash Price |
$3,759.60
|
| Rate for Payer: Cigna Commercial |
$5,326.10
|
| Rate for Payer: First Health Commercial |
$5,639.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,639.40
|
| Rate for Payer: GEHA Commercial |
$4,386.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,639.40
|
| Rate for Payer: Multiplan All |
$5,702.06
|
| Rate for Payer: OMNI Networks Commercial |
$4,386.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,639.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,952.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,699.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,827.38
|
| Rate for Payer: Zelis Auto |
$2,506.40
|
|
|
IMPLANT SYSTEM CITRELOCK XPRESS 5 X 10
|
Facility
|
OP
|
$6,266.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,566.50 |
| Max. Negotiated Rate |
$5,952.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,759.60
|
| Rate for Payer: Cash Price |
$3,759.60
|
| Rate for Payer: Cash Price |
$3,759.60
|
| Rate for Payer: Cigna Commercial |
$5,326.10
|
| Rate for Payer: First Health Commercial |
$5,639.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,639.40
|
| Rate for Payer: GEHA Commercial |
$5,012.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,639.40
|
| Rate for Payer: Humana ChoiceCare |
$1,629.16
|
| Rate for Payer: Multiplan All |
$5,702.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,759.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,386.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,639.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,952.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,699.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,514.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,566.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,827.38
|
| Rate for Payer: Zelis Auto |
$2,506.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,133.00
|
|
|
IMPLANT SYSTEM CITRELOCK XPRESS 5 X 15
|
Facility
|
OP
|
$6,266.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,566.50 |
| Max. Negotiated Rate |
$5,952.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,759.60
|
| Rate for Payer: Cash Price |
$3,759.60
|
| Rate for Payer: Cash Price |
$3,759.60
|
| Rate for Payer: Cigna Commercial |
$5,326.10
|
| Rate for Payer: First Health Commercial |
$5,639.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,639.40
|
| Rate for Payer: GEHA Commercial |
$5,012.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,639.40
|
| Rate for Payer: Humana ChoiceCare |
$1,629.16
|
| Rate for Payer: Multiplan All |
$5,702.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,759.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,386.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,639.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,952.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,699.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,514.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,566.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,827.38
|
| Rate for Payer: Zelis Auto |
$2,506.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,133.00
|
|
|
IMPLANT SYSTEM CITRELOCK XPRESS 5 X 15
|
Facility
|
IP
|
$6,266.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.40 |
| Max. Negotiated Rate |
$5,952.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,012.80
|
| Rate for Payer: Cash Price |
$3,759.60
|
| Rate for Payer: Cash Price |
$3,759.60
|
| Rate for Payer: Cigna Commercial |
$5,326.10
|
| Rate for Payer: First Health Commercial |
$5,639.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,639.40
|
| Rate for Payer: GEHA Commercial |
$4,386.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,639.40
|
| Rate for Payer: Multiplan All |
$5,702.06
|
| Rate for Payer: OMNI Networks Commercial |
$4,386.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,639.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,952.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,699.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,827.38
|
| Rate for Payer: Zelis Auto |
$2,506.40
|
|
|
IMPLANT SYSTEM SPEED BRIDGE
|
Facility
|
OP
|
$2,850.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$2,707.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,710.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cigna Commercial |
$2,422.50
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,565.00
|
| Rate for Payer: GEHA Commercial |
$2,280.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,565.00
|
| Rate for Payer: Humana ChoiceCare |
$741.00
|
| Rate for Payer: Multiplan All |
$2,593.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,710.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,995.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,565.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,707.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,137.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,508.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$712.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,650.50
|
| Rate for Payer: Zelis Auto |
$1,140.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,425.00
|
|
|
IMPLANT SYSTEM SPEED BRIDGE
|
Facility
|
IP
|
$2,850.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.00 |
| Max. Negotiated Rate |
$2,707.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,280.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cigna Commercial |
$2,422.50
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,565.00
|
| Rate for Payer: GEHA Commercial |
$1,995.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,565.00
|
| Rate for Payer: Multiplan All |
$2,593.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,995.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,565.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,707.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,137.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,650.50
|
| Rate for Payer: Zelis Auto |
$1,140.00
|
|
|
IMPLNT PATELLA 41MM ALL POLY
|
Facility
|
IP
|
$2,950.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,180.00 |
| Max. Negotiated Rate |
$2,802.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,360.00
|
| Rate for Payer: Cash Price |
$1,770.00
|
| Rate for Payer: Cash Price |
$1,770.00
|
| Rate for Payer: Cigna Commercial |
$2,507.50
|
| Rate for Payer: First Health Commercial |
$2,655.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,655.00
|
| Rate for Payer: GEHA Commercial |
$2,065.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,655.00
|
| Rate for Payer: Multiplan All |
$2,684.50
|
| Rate for Payer: OMNI Networks Commercial |
$2,065.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,655.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,802.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,212.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,743.50
|
| Rate for Payer: Zelis Auto |
$1,180.00
|
|
|
IMPLNT PATELLA 41MM ALL POLY
|
Facility
|
OP
|
$2,950.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.50 |
| Max. Negotiated Rate |
$2,802.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,770.00
|
| Rate for Payer: Cash Price |
$1,770.00
|
| Rate for Payer: Cash Price |
$1,770.00
|
| Rate for Payer: Cigna Commercial |
$2,507.50
|
| Rate for Payer: First Health Commercial |
$2,655.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,655.00
|
| Rate for Payer: GEHA Commercial |
$2,360.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,655.00
|
| Rate for Payer: Humana ChoiceCare |
$767.00
|
| Rate for Payer: Multiplan All |
$2,684.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,770.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,065.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,655.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,802.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,212.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,596.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$737.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,743.50
|
| Rate for Payer: Zelis Auto |
$1,180.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,475.00
|
|
|
IMPLNT STABILIZER
|
Facility
|
OP
|
$6,150.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.50 |
| Max. Negotiated Rate |
$5,842.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,690.00
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$5,227.50
|
| Rate for Payer: First Health Commercial |
$5,535.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,535.00
|
| Rate for Payer: GEHA Commercial |
$4,920.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,535.00
|
| Rate for Payer: Humana ChoiceCare |
$1,599.00
|
| Rate for Payer: Multiplan All |
$5,596.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,690.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,305.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,535.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,842.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,612.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,412.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,537.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,719.50
|
| Rate for Payer: Zelis Auto |
$2,460.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,075.00
|
|
|
IMPLNT STABILIZER
|
Facility
|
IP
|
$6,150.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.00 |
| Max. Negotiated Rate |
$5,842.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,920.00
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$5,227.50
|
| Rate for Payer: First Health Commercial |
$5,535.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,535.00
|
| Rate for Payer: GEHA Commercial |
$4,305.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,535.00
|
| Rate for Payer: Multiplan All |
$5,596.50
|
| Rate for Payer: OMNI Networks Commercial |
$4,305.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,535.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,842.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,612.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,719.50
|
| Rate for Payer: Zelis Auto |
$2,460.00
|
|
|
IMPLNT STEM EXTENSION 3MM OFFSET
|
Facility
|
OP
|
$10,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,527.50 |
| Max. Negotiated Rate |
$9,604.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,066.00
|
| Rate for Payer: Cash Price |
$6,066.00
|
| Rate for Payer: Cash Price |
$6,066.00
|
| Rate for Payer: Cigna Commercial |
$8,593.50
|
| Rate for Payer: First Health Commercial |
$9,099.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,099.00
|
| Rate for Payer: GEHA Commercial |
$8,088.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,099.00
|
| Rate for Payer: Humana ChoiceCare |
$2,628.60
|
| Rate for Payer: Multiplan All |
$9,200.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,066.00
|
| Rate for Payer: OMNI Networks Commercial |
$7,077.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9,099.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,604.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7,582.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,896.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,527.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,402.30
|
| Rate for Payer: Zelis Auto |
$4,044.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,055.00
|
|
|
IMPLNT STEM EXTENSION 3MM OFFSET
|
Facility
|
IP
|
$10,110.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,044.00 |
| Max. Negotiated Rate |
$9,604.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,088.00
|
| Rate for Payer: Cash Price |
$6,066.00
|
| Rate for Payer: Cash Price |
$6,066.00
|
| Rate for Payer: Cigna Commercial |
$8,593.50
|
| Rate for Payer: First Health Commercial |
$9,099.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,099.00
|
| Rate for Payer: GEHA Commercial |
$7,077.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,099.00
|
| Rate for Payer: Multiplan All |
$9,200.10
|
| Rate for Payer: OMNI Networks Commercial |
$7,077.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9,099.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,604.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7,582.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,402.30
|
| Rate for Payer: Zelis Auto |
$4,044.00
|
|
