|
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
|
|
|
IMPLT ANCH ICON 3 2.3MM
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000235
|
|
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 3 2.3MM
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000235
|
|
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 JUGRNT TPR NEEDLE
|
Facility
|
OP
|
$1,682.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.50 |
| Max. Negotiated Rate |
$1,597.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,009.20
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cigna Commercial |
$1,429.70
|
| Rate for Payer: First Health Commercial |
$1,513.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,513.80
|
| Rate for Payer: GEHA Commercial |
$1,345.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,513.80
|
| Rate for Payer: Humana ChoiceCare |
$437.32
|
| Rate for Payer: Multiplan All |
$1,530.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,009.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,177.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,513.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,597.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,261.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,480.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$420.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,564.26
|
| Rate for Payer: Zelis Auto |
$672.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$841.00
|
|
|
IMPLT ANCH JUGRNT TPR NEEDLE
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.80 |
| Max. Negotiated Rate |
$1,597.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,345.60
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cigna Commercial |
$1,429.70
|
| Rate for Payer: First Health Commercial |
$1,513.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,513.80
|
| Rate for Payer: GEHA Commercial |
$1,177.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,513.80
|
| Rate for Payer: Multiplan All |
$1,530.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,177.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,513.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,597.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,261.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,564.26
|
| Rate for Payer: Zelis Auto |
$672.80
|
|
|
IMPLT ANCHOR 1.9 W/ULTRABRAID CURVED
|
Facility
|
IP
|
$1,573.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.20 |
| Max. Negotiated Rate |
$1,494.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,258.40
|
| Rate for Payer: Cash Price |
$943.80
|
| Rate for Payer: Cash Price |
$943.80
|
| Rate for Payer: Cigna Commercial |
$1,337.05
|
| Rate for Payer: First Health Commercial |
$1,415.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,415.70
|
| Rate for Payer: GEHA Commercial |
$1,101.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,415.70
|
| Rate for Payer: Multiplan All |
$1,431.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,101.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,415.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,494.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,179.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,462.89
|
| Rate for Payer: Zelis Auto |
$629.20
|
|
|
IMPLT ANCHOR 1.9 W/ULTRABRAID CURVED
|
Facility
|
OP
|
$1,573.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.25 |
| Max. Negotiated Rate |
$1,494.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$943.80
|
| Rate for Payer: Cash Price |
$943.80
|
| Rate for Payer: Cash Price |
$943.80
|
| Rate for Payer: Cigna Commercial |
$1,337.05
|
| Rate for Payer: First Health Commercial |
$1,415.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,415.70
|
| Rate for Payer: GEHA Commercial |
$1,258.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,415.70
|
| Rate for Payer: Humana ChoiceCare |
$408.98
|
| Rate for Payer: Multiplan All |
$1,431.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$943.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,101.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,415.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,494.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,179.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,384.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$393.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,462.89
|
| Rate for Payer: Zelis Auto |
$629.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$786.50
|
|
|
IMPLT ANCHOR 25 ICONIX #5 FIBER FORCE
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000231
|
|
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 ANCHOR 25 ICONIX #5 FIBER FORCE
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000231
|
|
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 ANCHOR 3.5MM PEEK SE TWIN
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.50 |
| Max. Negotiated Rate |
$1,081.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$682.80
|
| Rate for Payer: Cash Price |
$682.80
|
| Rate for Payer: Cash Price |
$682.80
|
| Rate for Payer: Cigna Commercial |
$967.30
|
| Rate for Payer: First Health Commercial |
$1,024.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,024.20
|
| Rate for Payer: GEHA Commercial |
$910.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,024.20
|
| Rate for Payer: Humana ChoiceCare |
$295.88
|
| Rate for Payer: Multiplan All |
$1,035.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$682.80
|
| Rate for Payer: OMNI Networks Commercial |
$796.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,024.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,081.10
|
| Rate for Payer: Three Rivers Provider Network All |
$853.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,001.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$284.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,058.34
|
| Rate for Payer: Zelis Auto |
$455.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$569.00
|
|
|
IMPLT ANCHOR 3.5MM PEEK SE TWIN
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.20 |
| Max. Negotiated Rate |
$1,081.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$910.40
|
| Rate for Payer: Cash Price |
$682.80
|
| Rate for Payer: Cash Price |
$682.80
|
| Rate for Payer: Cigna Commercial |
$967.30
|
| Rate for Payer: First Health Commercial |
$1,024.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,024.20
|
| Rate for Payer: GEHA Commercial |
$796.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,024.20
|
| Rate for Payer: Multiplan All |
$1,035.58
|
| Rate for Payer: OMNI Networks Commercial |
$796.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,024.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,081.10
|
| Rate for Payer: Three Rivers Provider Network All |
$853.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,058.34
|
| Rate for Payer: Zelis Auto |
$455.20
|
|
|
IMPLT ANCHOR,5.5MM,REELX STT
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.50 |
| Max. Negotiated Rate |
$1,776.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cigna Commercial |
$1,589.50
|
| Rate for Payer: First Health Commercial |
$1,683.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,683.00
|
| Rate for Payer: GEHA Commercial |
$1,496.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,683.00
|
| Rate for Payer: Humana ChoiceCare |
$486.20
|
| Rate for Payer: Multiplan All |
$1,701.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,122.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,309.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,683.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,776.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,645.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$467.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,739.10
|
| Rate for Payer: Zelis Auto |
$748.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$935.00
|
|
|
IMPLT ANCHOR,5.5MM,REELX STT
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.00 |
| Max. Negotiated Rate |
$1,776.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,496.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cigna Commercial |
$1,589.50
|
| Rate for Payer: First Health Commercial |
$1,683.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,683.00
|
| Rate for Payer: GEHA Commercial |
$1,309.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,683.00
|
| Rate for Payer: Multiplan All |
$1,701.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,309.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,683.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,776.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,402.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,739.10
|
| Rate for Payer: Zelis Auto |
$748.00
|
|
|
IMPLT ANCHOR BONE
|
Facility
|
OP
|
$4,530.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.50 |
| Max. Negotiated Rate |
$4,303.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,718.00
|
| Rate for Payer: Cash Price |
$2,718.00
|
| Rate for Payer: Cash Price |
$2,718.00
|
| Rate for Payer: Cigna Commercial |
$3,850.50
|
| Rate for Payer: First Health Commercial |
$4,077.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,077.00
|
| Rate for Payer: GEHA Commercial |
$3,624.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,077.00
|
| Rate for Payer: Humana ChoiceCare |
$1,177.80
|
| Rate for Payer: Multiplan All |
$4,122.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,718.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,171.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,077.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,303.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,397.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,986.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,132.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,212.90
|
| Rate for Payer: Zelis Auto |
$1,812.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,265.00
|
|
|
IMPLT ANCHOR BONE
|
Facility
|
IP
|
$4,530.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.00 |
| Max. Negotiated Rate |
$4,303.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,624.00
|
| Rate for Payer: Cash Price |
$2,718.00
|
| Rate for Payer: Cash Price |
$2,718.00
|
| Rate for Payer: Cigna Commercial |
$3,850.50
|
| Rate for Payer: First Health Commercial |
$4,077.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,077.00
|
| Rate for Payer: GEHA Commercial |
$3,171.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,077.00
|
| Rate for Payer: Multiplan All |
$4,122.30
|
| Rate for Payer: OMNI Networks Commercial |
$3,171.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,077.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,303.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,397.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,212.90
|
| Rate for Payer: Zelis Auto |
$1,812.00
|
|
|
IMPLT ANCHOR CINCHLOCK KNOTLESS
|
Facility
|
IP
|
$2,030.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$812.00 |
| Max. Negotiated Rate |
$1,928.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,624.00
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$1,725.50
|
| Rate for Payer: First Health Commercial |
$1,827.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,827.00
|
| Rate for Payer: GEHA Commercial |
$1,421.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,827.00
|
| Rate for Payer: Multiplan All |
$1,847.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,421.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,827.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,928.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,522.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,887.90
|
| Rate for Payer: Zelis Auto |
$812.00
|
|
|
IMPLT ANCHOR CINCHLOCK KNOTLESS
|
Facility
|
OP
|
$2,030.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.50 |
| Max. Negotiated Rate |
$1,928.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,218.00
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$1,725.50
|
| Rate for Payer: First Health Commercial |
$1,827.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,827.00
|
| Rate for Payer: GEHA Commercial |
$1,624.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,827.00
|
| Rate for Payer: Humana ChoiceCare |
$527.80
|
| Rate for Payer: Multiplan All |
$1,847.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,218.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,421.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,827.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,928.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,522.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,786.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$507.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,887.90
|
| Rate for Payer: Zelis Auto |
$812.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,015.00
|
|
|
IMPLT ANCHOR CORKSCREW 5.5MM
|
Facility
|
IP
|
$1,589.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.60 |
| Max. Negotiated Rate |
$1,509.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,271.20
|
| Rate for Payer: Cash Price |
$953.40
|
| Rate for Payer: Cash Price |
$953.40
|
| Rate for Payer: Cigna Commercial |
$1,350.65
|
| Rate for Payer: First Health Commercial |
$1,430.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,430.10
|
| Rate for Payer: GEHA Commercial |
$1,112.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,430.10
|
| Rate for Payer: Multiplan All |
$1,445.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,112.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,430.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,509.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,191.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,477.77
|
| Rate for Payer: Zelis Auto |
$635.60
|
|
|
IMPLT ANCHOR CORKSCREW 5.5MM
|
Facility
|
OP
|
$1,589.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$397.25 |
| Max. Negotiated Rate |
$1,509.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$953.40
|
| Rate for Payer: Cash Price |
$953.40
|
| Rate for Payer: Cash Price |
$953.40
|
| Rate for Payer: Cigna Commercial |
$1,350.65
|
| Rate for Payer: First Health Commercial |
$1,430.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,430.10
|
| Rate for Payer: GEHA Commercial |
$1,271.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,430.10
|
| Rate for Payer: Humana ChoiceCare |
$413.14
|
| Rate for Payer: Multiplan All |
$1,445.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$953.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,112.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,430.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,509.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,191.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,398.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$397.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,477.77
|
| Rate for Payer: Zelis Auto |
$635.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$794.50
|
|
|
IMPLT ANCHOR CORKSCREW SUTURE 5.5X14.7MM
|
Facility
|
IP
|
$2,227.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.80 |
| Max. Negotiated Rate |
$2,115.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,781.60
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$1,892.95
|
| Rate for Payer: First Health Commercial |
$2,004.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,004.30
|
| Rate for Payer: GEHA Commercial |
$1,558.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,004.30
|
| Rate for Payer: Multiplan All |
$2,026.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,558.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,004.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,115.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,670.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,071.11
|
| Rate for Payer: Zelis Auto |
$890.80
|
|
|
IMPLT ANCHOR CORKSCREW SUTURE 5.5X14.7MM
|
Facility
|
OP
|
$2,227.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.75 |
| Max. Negotiated Rate |
$2,115.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,336.20
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$1,892.95
|
| Rate for Payer: First Health Commercial |
$2,004.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,004.30
|
| Rate for Payer: GEHA Commercial |
$1,781.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,004.30
|
| Rate for Payer: Humana ChoiceCare |
$579.02
|
| Rate for Payer: Multiplan All |
$2,026.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,336.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,558.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,004.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,115.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,670.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,959.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$556.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,071.11
|
| Rate for Payer: Zelis Auto |
$890.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,113.50
|
|
|
IMPLT ANCHOR ICONIX 2.3MM
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$406.40
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
|
|
IMPLT ANCHOR ICONIX 2.3MM
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$132.08
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$304.80
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$447.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$254.00
|
|
|
IMPLT ANCHOR PEEK ZIP 5.5MM
|
Facility
|
IP
|
$1,272.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.80 |
| Max. Negotiated Rate |
$1,208.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,017.60
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna Commercial |
$1,081.20
|
| Rate for Payer: First Health Commercial |
$1,144.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,144.80
|
| Rate for Payer: GEHA Commercial |
$890.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,144.80
|
| Rate for Payer: Multiplan All |
$1,157.52
|
| Rate for Payer: OMNI Networks Commercial |
$890.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,144.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,208.40
|
| Rate for Payer: Three Rivers Provider Network All |
$954.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,182.96
|
| Rate for Payer: Zelis Auto |
$508.80
|
|
|
IMPLT ANCHOR PEEK ZIP 5.5MM
|
Facility
|
OP
|
$1,272.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,208.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna Commercial |
$1,081.20
|
| Rate for Payer: First Health Commercial |
$1,144.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,144.80
|
| Rate for Payer: GEHA Commercial |
$1,017.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,144.80
|
| Rate for Payer: Humana ChoiceCare |
$330.72
|
| Rate for Payer: Multiplan All |
$1,157.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$763.20
|
| Rate for Payer: OMNI Networks Commercial |
$890.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,144.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,208.40
|
| Rate for Payer: Three Rivers Provider Network All |
$954.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,119.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$318.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,182.96
|
| Rate for Payer: Zelis Auto |
$508.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$636.00
|
|
