|
IMPLT AMS 700 CX MS PUMP IZ
|
Facility
|
OP
|
$27,028.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7003321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,757.00 |
| Max. Negotiated Rate |
$25,676.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16,216.80
|
| Rate for Payer: Cash Price |
$16,216.80
|
| Rate for Payer: Cash Price |
$16,216.80
|
| Rate for Payer: Cigna Commercial |
$22,973.80
|
| Rate for Payer: First Health Commercial |
$24,325.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24,325.20
|
| Rate for Payer: GEHA Commercial |
$21,622.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24,325.20
|
| Rate for Payer: Humana ChoiceCare |
$7,027.28
|
| Rate for Payer: Multiplan All |
$24,595.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,216.80
|
| Rate for Payer: OMNI Networks Commercial |
$18,919.60
|
| Rate for Payer: One Health Plan PPO/POS |
$24,325.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$25,676.60
|
| Rate for Payer: Three Rivers Provider Network All |
$20,271.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23,784.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,757.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25,136.04
|
| Rate for Payer: Zelis Auto |
$10,811.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13,514.00
|
|
|
IMPLT AMS 700 CX MS PUMP IZ
|
Facility
|
IP
|
$27,028.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7003321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,811.20 |
| Max. Negotiated Rate |
$25,676.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21,622.40
|
| Rate for Payer: Cash Price |
$16,216.80
|
| Rate for Payer: Cash Price |
$16,216.80
|
| Rate for Payer: Cigna Commercial |
$22,973.80
|
| Rate for Payer: First Health Commercial |
$24,325.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24,325.20
|
| Rate for Payer: GEHA Commercial |
$18,919.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24,325.20
|
| Rate for Payer: Multiplan All |
$24,595.48
|
| Rate for Payer: OMNI Networks Commercial |
$18,919.60
|
| Rate for Payer: One Health Plan PPO/POS |
$24,325.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$25,676.60
|
| Rate for Payer: Three Rivers Provider Network All |
$20,271.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25,136.04
|
| Rate for Payer: Zelis Auto |
$10,811.20
|
|
|
IMPLT AMS 700 LGX MS PUMP IZ
|
Facility
|
IP
|
$27,523.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7003054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,009.20 |
| Max. Negotiated Rate |
$26,146.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22,018.40
|
| Rate for Payer: Cash Price |
$16,513.80
|
| Rate for Payer: Cash Price |
$16,513.80
|
| Rate for Payer: Cigna Commercial |
$23,394.55
|
| Rate for Payer: First Health Commercial |
$24,770.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24,770.70
|
| Rate for Payer: GEHA Commercial |
$19,266.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24,770.70
|
| Rate for Payer: Multiplan All |
$25,045.93
|
| Rate for Payer: OMNI Networks Commercial |
$19,266.10
|
| Rate for Payer: One Health Plan PPO/POS |
$24,770.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$26,146.85
|
| Rate for Payer: Three Rivers Provider Network All |
$20,642.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25,596.39
|
| Rate for Payer: Zelis Auto |
$11,009.20
|
|
|
IMPLT AMS 700 LGX MS PUMP IZ
|
Facility
|
OP
|
$27,523.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7003054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,880.75 |
| Max. Negotiated Rate |
$26,146.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16,513.80
|
| Rate for Payer: Cash Price |
$16,513.80
|
| Rate for Payer: Cash Price |
$16,513.80
|
| Rate for Payer: Cigna Commercial |
$23,394.55
|
| Rate for Payer: First Health Commercial |
$24,770.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24,770.70
|
| Rate for Payer: GEHA Commercial |
$22,018.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24,770.70
|
| Rate for Payer: Humana ChoiceCare |
$7,155.98
|
| Rate for Payer: Multiplan All |
$25,045.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,513.80
|
| Rate for Payer: OMNI Networks Commercial |
$19,266.10
|
| Rate for Payer: One Health Plan PPO/POS |
$24,770.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$26,146.85
|
| Rate for Payer: Three Rivers Provider Network All |
$20,642.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24,220.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,880.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25,596.39
|
| Rate for Payer: Zelis Auto |
$11,009.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13,761.50
|
|
|
IMPLT AMS LGX MS PUMP
|
Facility
|
IP
|
$27,523.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7006360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,009.20 |
| Max. Negotiated Rate |
$26,146.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22,018.40
|
| Rate for Payer: Cash Price |
$16,513.80
|
| Rate for Payer: Cash Price |
$16,513.80
|
| Rate for Payer: Cigna Commercial |
$23,394.55
|
| Rate for Payer: First Health Commercial |
$24,770.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24,770.70
|
| Rate for Payer: GEHA Commercial |
$19,266.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24,770.70
|
| Rate for Payer: Multiplan All |
$25,045.93
|
| Rate for Payer: OMNI Networks Commercial |
$19,266.10
|
| Rate for Payer: One Health Plan PPO/POS |
$24,770.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$26,146.85
|
| Rate for Payer: Three Rivers Provider Network All |
$20,642.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25,596.39
|
| Rate for Payer: Zelis Auto |
$11,009.20
|
|
|
IMPLT AMS LGX MS PUMP
|
Facility
|
OP
|
$27,523.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7006360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,880.75 |
| Max. Negotiated Rate |
$26,146.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16,513.80
|
| Rate for Payer: Cash Price |
$16,513.80
|
| Rate for Payer: Cash Price |
$16,513.80
|
| Rate for Payer: Cigna Commercial |
$23,394.55
|
| Rate for Payer: First Health Commercial |
$24,770.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24,770.70
|
| Rate for Payer: GEHA Commercial |
$22,018.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24,770.70
|
| Rate for Payer: Humana ChoiceCare |
$7,155.98
|
| Rate for Payer: Multiplan All |
$25,045.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,513.80
|
| Rate for Payer: OMNI Networks Commercial |
$19,266.10
|
| Rate for Payer: One Health Plan PPO/POS |
$24,770.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$26,146.85
|
| Rate for Payer: Three Rivers Provider Network All |
$20,642.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24,220.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,880.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25,596.39
|
| Rate for Payer: Zelis Auto |
$11,009.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13,761.50
|
|
|
IMPLT AMS MS PUMP
|
Facility
|
IP
|
$27,523.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7006368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,009.20 |
| Max. Negotiated Rate |
$26,146.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22,018.40
|
| Rate for Payer: Cash Price |
$16,513.80
|
| Rate for Payer: Cash Price |
$16,513.80
|
| Rate for Payer: Cigna Commercial |
$23,394.55
|
| Rate for Payer: First Health Commercial |
$24,770.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24,770.70
|
| Rate for Payer: GEHA Commercial |
$19,266.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24,770.70
|
| Rate for Payer: Multiplan All |
$25,045.93
|
| Rate for Payer: OMNI Networks Commercial |
$19,266.10
|
| Rate for Payer: One Health Plan PPO/POS |
$24,770.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$26,146.85
|
| Rate for Payer: Three Rivers Provider Network All |
$20,642.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25,596.39
|
| Rate for Payer: Zelis Auto |
$11,009.20
|
|
|
IMPLT AMS MS PUMP
|
Facility
|
OP
|
$27,523.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7006368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,880.75 |
| Max. Negotiated Rate |
$26,146.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16,513.80
|
| Rate for Payer: Cash Price |
$16,513.80
|
| Rate for Payer: Cash Price |
$16,513.80
|
| Rate for Payer: Cigna Commercial |
$23,394.55
|
| Rate for Payer: First Health Commercial |
$24,770.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24,770.70
|
| Rate for Payer: GEHA Commercial |
$22,018.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24,770.70
|
| Rate for Payer: Humana ChoiceCare |
$7,155.98
|
| Rate for Payer: Multiplan All |
$25,045.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,513.80
|
| Rate for Payer: OMNI Networks Commercial |
$19,266.10
|
| Rate for Payer: One Health Plan PPO/POS |
$24,770.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$26,146.85
|
| Rate for Payer: Three Rivers Provider Network All |
$20,642.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24,220.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,880.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25,596.39
|
| Rate for Payer: Zelis Auto |
$11,009.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13,761.50
|
|
|
IMPLT AMS MS PUMP
|
Facility
|
OP
|
$32,151.45
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7006430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,037.86 |
| Max. Negotiated Rate |
$30,543.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19,290.87
|
| Rate for Payer: Cash Price |
$19,290.87
|
| Rate for Payer: Cash Price |
$19,290.87
|
| Rate for Payer: Cigna Commercial |
$27,328.73
|
| Rate for Payer: First Health Commercial |
$28,936.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28,936.31
|
| Rate for Payer: GEHA Commercial |
$25,721.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28,936.31
|
| Rate for Payer: Humana ChoiceCare |
$8,359.38
|
| Rate for Payer: Multiplan All |
$29,257.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19,290.87
|
| Rate for Payer: OMNI Networks Commercial |
$22,506.01
|
| Rate for Payer: One Health Plan PPO/POS |
$28,936.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30,543.88
|
| Rate for Payer: Three Rivers Provider Network All |
$24,113.59
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28,293.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,037.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29,900.85
|
| Rate for Payer: Zelis Auto |
$12,860.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16,075.73
|
|
|
IMPLT AMS MS PUMP
|
Facility
|
IP
|
$32,151.45
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7006430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,860.58 |
| Max. Negotiated Rate |
$30,543.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$25,721.16
|
| Rate for Payer: Cash Price |
$19,290.87
|
| Rate for Payer: Cash Price |
$19,290.87
|
| Rate for Payer: Cigna Commercial |
$27,328.73
|
| Rate for Payer: First Health Commercial |
$28,936.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28,936.31
|
| Rate for Payer: GEHA Commercial |
$22,506.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28,936.31
|
| Rate for Payer: Multiplan All |
$29,257.82
|
| Rate for Payer: OMNI Networks Commercial |
$22,506.01
|
| Rate for Payer: One Health Plan PPO/POS |
$28,936.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30,543.88
|
| Rate for Payer: Three Rivers Provider Network All |
$24,113.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29,900.85
|
| Rate for Payer: Zelis Auto |
$12,860.58
|
|
|
IMPLT ANCH BIORPTR 2.3MM
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$311.50 |
| Max. Negotiated Rate |
$1,183.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$747.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$1,059.10
|
| Rate for Payer: First Health Commercial |
$1,121.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,121.40
|
| Rate for Payer: GEHA Commercial |
$996.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,121.40
|
| Rate for Payer: Humana ChoiceCare |
$323.96
|
| Rate for Payer: Multiplan All |
$1,133.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$747.60
|
| Rate for Payer: OMNI Networks Commercial |
$872.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,121.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,183.70
|
| Rate for Payer: Three Rivers Provider Network All |
$934.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,096.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$311.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,158.78
|
| Rate for Payer: Zelis Auto |
$498.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$623.00
|
|
|
IMPLT ANCH BIORPTR 2.3MM
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$498.40 |
| Max. Negotiated Rate |
$1,183.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$996.80
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$1,059.10
|
| Rate for Payer: First Health Commercial |
$1,121.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,121.40
|
| Rate for Payer: GEHA Commercial |
$872.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,121.40
|
| Rate for Payer: Multiplan All |
$1,133.86
|
| Rate for Payer: OMNI Networks Commercial |
$872.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,121.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,183.70
|
| Rate for Payer: Three Rivers Provider Network All |
$934.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,158.78
|
| Rate for Payer: Zelis Auto |
$498.40
|
|
|
IMPLT ANCH CRKSCRW 2.2MM
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.50 |
| Max. Negotiated Rate |
$1,814.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,146.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$1,623.50
|
| Rate for Payer: First Health Commercial |
$1,719.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,719.00
|
| Rate for Payer: GEHA Commercial |
$1,528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,719.00
|
| Rate for Payer: Humana ChoiceCare |
$496.60
|
| Rate for Payer: Multiplan All |
$1,738.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,146.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,337.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,719.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,814.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,432.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,680.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$477.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,776.30
|
| Rate for Payer: Zelis Auto |
$764.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$955.00
|
|
|
IMPLT ANCH CRKSCRW 2.2MM
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$764.00 |
| Max. Negotiated Rate |
$1,814.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,528.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$1,623.50
|
| Rate for Payer: First Health Commercial |
$1,719.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,719.00
|
| Rate for Payer: GEHA Commercial |
$1,337.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,719.00
|
| Rate for Payer: Multiplan All |
$1,738.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,337.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,719.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,814.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,432.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,776.30
|
| Rate for Payer: Zelis Auto |
$764.00
|
|
|
IMPLT ANCH CRKSCRW 2.7x7MM
|
Facility
|
OP
|
$1,411.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.75 |
| Max. Negotiated Rate |
$1,340.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$846.60
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,269.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,269.90
|
| Rate for Payer: GEHA Commercial |
$1,128.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,269.90
|
| Rate for Payer: Humana ChoiceCare |
$366.86
|
| Rate for Payer: Multiplan All |
$1,284.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$846.60
|
| Rate for Payer: OMNI Networks Commercial |
$987.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,269.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,340.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,058.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,241.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$352.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,312.23
|
| Rate for Payer: Zelis Auto |
$564.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$705.50
|
|
|
IMPLT ANCH CRKSCRW 2.7x7MM
|
Facility
|
IP
|
$1,411.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.40 |
| Max. Negotiated Rate |
$1,340.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,128.80
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,269.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,269.90
|
| Rate for Payer: GEHA Commercial |
$987.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,269.90
|
| Rate for Payer: Multiplan All |
$1,284.01
|
| Rate for Payer: OMNI Networks Commercial |
$987.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,269.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,340.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,058.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,312.23
|
| Rate for Payer: Zelis Auto |
$564.40
|
|
|
IMPLT ANCH CRKSCRW 3.5MM
|
Facility
|
IP
|
$1,045.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.00 |
| Max. Negotiated Rate |
$992.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$836.00
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cigna Commercial |
$888.25
|
| Rate for Payer: First Health Commercial |
$940.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$940.50
|
| Rate for Payer: GEHA Commercial |
$731.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$940.50
|
| Rate for Payer: Multiplan All |
$950.95
|
| Rate for Payer: OMNI Networks Commercial |
$731.50
|
| Rate for Payer: One Health Plan PPO/POS |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$992.75
|
| Rate for Payer: Three Rivers Provider Network All |
$783.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$971.85
|
| Rate for Payer: Zelis Auto |
$418.00
|
|
|
IMPLT ANCH CRKSCRW 3.5MM
|
Facility
|
OP
|
$1,045.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.25 |
| Max. Negotiated Rate |
$992.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$627.00
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cigna Commercial |
$888.25
|
| Rate for Payer: First Health Commercial |
$940.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$940.50
|
| Rate for Payer: GEHA Commercial |
$836.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$940.50
|
| Rate for Payer: Humana ChoiceCare |
$271.70
|
| Rate for Payer: Multiplan All |
$950.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$627.00
|
| Rate for Payer: OMNI Networks Commercial |
$731.50
|
| Rate for Payer: One Health Plan PPO/POS |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$992.75
|
| Rate for Payer: Three Rivers Provider Network All |
$783.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$919.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$261.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$971.85
|
| Rate for Payer: Zelis Auto |
$418.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$522.50
|
|
|
IMPLT ANCH CRKSCRW 5.5MM
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.60 |
| Max. Negotiated Rate |
$1,224.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,031.20
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,095.65
|
| Rate for Payer: First Health Commercial |
$1,160.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.10
|
| Rate for Payer: GEHA Commercial |
$902.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.10
|
| Rate for Payer: Multiplan All |
$1,172.99
|
| Rate for Payer: OMNI Networks Commercial |
$902.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.55
|
| Rate for Payer: Three Rivers Provider Network All |
$966.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.77
|
| Rate for Payer: Zelis Auto |
$515.60
|
|
|
IMPLT ANCH CRKSCRW 5.5MM
|
Facility
|
OP
|
$1,289.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.25 |
| Max. Negotiated Rate |
$1,224.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,095.65
|
| Rate for Payer: First Health Commercial |
$1,160.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.10
|
| Rate for Payer: GEHA Commercial |
$1,031.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.10
|
| Rate for Payer: Humana ChoiceCare |
$335.14
|
| Rate for Payer: Multiplan All |
$1,172.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$773.40
|
| Rate for Payer: OMNI Networks Commercial |
$902.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.55
|
| Rate for Payer: Three Rivers Provider Network All |
$966.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,134.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$322.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.77
|
| Rate for Payer: Zelis Auto |
$515.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$644.50
|
|
|
IMPLT ANCH FASTAK 7.5MM
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.50 |
| Max. Negotiated Rate |
$1,814.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,146.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$1,623.50
|
| Rate for Payer: First Health Commercial |
$1,719.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,719.00
|
| Rate for Payer: GEHA Commercial |
$1,528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,719.00
|
| Rate for Payer: Humana ChoiceCare |
$496.60
|
| Rate for Payer: Multiplan All |
$1,738.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,146.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,337.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,719.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,814.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,432.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,680.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$477.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,776.30
|
| Rate for Payer: Zelis Auto |
$764.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$955.00
|
|
|
IMPLT ANCH FASTAK 7.5MM
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$764.00 |
| Max. Negotiated Rate |
$1,814.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,528.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$1,623.50
|
| Rate for Payer: First Health Commercial |
$1,719.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,719.00
|
| Rate for Payer: GEHA Commercial |
$1,337.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,719.00
|
| Rate for Payer: Multiplan All |
$1,738.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,337.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,719.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,814.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,432.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,776.30
|
| Rate for Payer: Zelis Auto |
$764.00
|
|
|
IMPLT ANCH ICON 1 1.4MM STRAND SINGLE
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.75 |
| Max. Negotiated Rate |
$1,591.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,423.75
|
| Rate for Payer: First Health Commercial |
$1,507.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,507.50
|
| Rate for Payer: GEHA Commercial |
$1,340.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,507.50
|
| Rate for Payer: Humana ChoiceCare |
$435.50
|
| Rate for Payer: Multiplan All |
$1,524.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,005.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,172.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,507.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,591.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,256.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,474.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$418.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,557.75
|
| Rate for Payer: Zelis Auto |
$670.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$837.50
|
|
|
IMPLT ANCH ICON 1 1.4MM STRAND SINGLE
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.00 |
| Max. Negotiated Rate |
$1,591.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,340.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,423.75
|
| Rate for Payer: First Health Commercial |
$1,507.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,507.50
|
| Rate for Payer: GEHA Commercial |
$1,172.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,507.50
|
| Rate for Payer: Multiplan All |
$1,524.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,172.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,507.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,591.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,256.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,557.75
|
| Rate for Payer: Zelis Auto |
$670.00
|
|
|
IMPLT ANCH ICON 2 2.3MM
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.00 |
| Max. Negotiated Rate |
$1,591.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,340.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,423.75
|
| Rate for Payer: First Health Commercial |
$1,507.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,507.50
|
| Rate for Payer: GEHA Commercial |
$1,172.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,507.50
|
| Rate for Payer: Multiplan All |
$1,524.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,172.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,507.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,591.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,256.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,557.75
|
| Rate for Payer: Zelis Auto |
$670.00
|
|
