|
IMPLT ANCHOR QFIX 1.8MM
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006601
|
|
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 QFIX 1.8MM
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006601
|
|
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 QFIX 2.8MM
|
Facility
|
OP
|
$1,776.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.00 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$1,509.60
|
| Rate for Payer: First Health Commercial |
$1,598.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,598.40
|
| Rate for Payer: GEHA Commercial |
$1,420.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,598.40
|
| Rate for Payer: Humana ChoiceCare |
$461.76
|
| Rate for Payer: Multiplan All |
$1,616.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,065.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,243.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,598.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,687.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,332.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,562.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$444.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,651.68
|
| Rate for Payer: Zelis Auto |
$710.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$888.00
|
|
|
IMPLT ANCHOR QFIX 2.8MM
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.40 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,420.80
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$1,509.60
|
| Rate for Payer: First Health Commercial |
$1,598.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,598.40
|
| Rate for Payer: GEHA Commercial |
$1,243.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,598.40
|
| Rate for Payer: Multiplan All |
$1,616.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,243.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,598.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,687.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,332.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,651.68
|
| Rate for Payer: Zelis Auto |
$710.40
|
|
|
IMPLT ANCHOR QUICK MITEK SIZE 2
|
Facility
|
IP
|
$1,926.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.40 |
| Max. Negotiated Rate |
$1,829.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,540.80
|
| Rate for Payer: Cash Price |
$1,155.60
|
| Rate for Payer: Cash Price |
$1,155.60
|
| Rate for Payer: Cigna Commercial |
$1,637.10
|
| Rate for Payer: First Health Commercial |
$1,733.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,733.40
|
| Rate for Payer: GEHA Commercial |
$1,348.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,733.40
|
| Rate for Payer: Multiplan All |
$1,752.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,348.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,733.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,829.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,444.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,791.18
|
| Rate for Payer: Zelis Auto |
$770.40
|
|
|
IMPLT ANCHOR QUICK MITEK SIZE 2
|
Facility
|
OP
|
$1,926.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.50 |
| Max. Negotiated Rate |
$1,829.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,155.60
|
| Rate for Payer: Cash Price |
$1,155.60
|
| Rate for Payer: Cash Price |
$1,155.60
|
| Rate for Payer: Cigna Commercial |
$1,637.10
|
| Rate for Payer: First Health Commercial |
$1,733.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,733.40
|
| Rate for Payer: GEHA Commercial |
$1,540.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,733.40
|
| Rate for Payer: Humana ChoiceCare |
$500.76
|
| Rate for Payer: Multiplan All |
$1,752.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,155.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,348.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,733.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,829.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,444.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,694.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$481.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,791.18
|
| Rate for Payer: Zelis Auto |
$770.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$963.00
|
|
|
IMPLT ANCHOR SCREW W/NEEDLE 5MM T1
|
Facility
|
IP
|
$1,403.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.20 |
| Max. Negotiated Rate |
$1,332.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,122.40
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cigna Commercial |
$1,192.55
|
| Rate for Payer: First Health Commercial |
$1,262.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,262.70
|
| Rate for Payer: GEHA Commercial |
$982.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,262.70
|
| Rate for Payer: Multiplan All |
$1,276.73
|
| Rate for Payer: OMNI Networks Commercial |
$982.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,262.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,332.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,052.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,304.79
|
| Rate for Payer: Zelis Auto |
$561.20
|
|
|
IMPLT ANCHOR SCREW W/NEEDLE 5MM T1
|
Facility
|
OP
|
$1,403.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.75 |
| Max. Negotiated Rate |
$1,332.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.80
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cigna Commercial |
$1,192.55
|
| Rate for Payer: First Health Commercial |
$1,262.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,262.70
|
| Rate for Payer: GEHA Commercial |
$1,122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,262.70
|
| Rate for Payer: Humana ChoiceCare |
$364.78
|
| Rate for Payer: Multiplan All |
$1,276.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$841.80
|
| Rate for Payer: OMNI Networks Commercial |
$982.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,262.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,332.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,052.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,234.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$350.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,304.79
|
| Rate for Payer: Zelis Auto |
$561.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$701.50
|
|
|
IMPLT ANCHOR SUTURE 2.9X12.5MM COMPOSITE
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.20 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,502.40
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$1,596.30
|
| Rate for Payer: First Health Commercial |
$1,690.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.20
|
| Rate for Payer: GEHA Commercial |
$1,314.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.20
|
| Rate for Payer: Multiplan All |
$1,708.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,746.54
|
| Rate for Payer: Zelis Auto |
$751.20
|
|
|
IMPLT ANCHOR SUTURE 2.9X12.5MM COMPOSITE
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.50 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$1,596.30
|
| Rate for Payer: First Health Commercial |
$1,690.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.20
|
| Rate for Payer: GEHA Commercial |
$1,502.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.20
|
| Rate for Payer: Humana ChoiceCare |
$488.28
|
| Rate for Payer: Multiplan All |
$1,708.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,126.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,652.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$469.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,746.54
|
| Rate for Payer: Zelis Auto |
$751.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$939.00
|
|
|
IMPLT ANCHOR SUTURE 3.5
|
Facility
|
OP
|
$1,014.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.50 |
| Max. Negotiated Rate |
$963.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$811.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| Rate for Payer: Humana ChoiceCare |
$263.64
|
| Rate for Payer: Multiplan All |
$922.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$608.40
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$963.30
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$892.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$253.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.02
|
| Rate for Payer: Zelis Auto |
$405.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$507.00
|
|
|
IMPLT ANCHOR SUTURE 3.5
|
Facility
|
IP
|
$1,014.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.60 |
| Max. Negotiated Rate |
$963.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$811.20
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$709.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| Rate for Payer: Multiplan All |
$922.74
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$963.30
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.02
|
| Rate for Payer: Zelis Auto |
$405.60
|
|
|
IMPLT ANCHOR SUTURE 5.5
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$385.50 |
| Max. Negotiated Rate |
$1,464.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$925.20
|
| Rate for Payer: Cash Price |
$925.20
|
| Rate for Payer: Cash Price |
$925.20
|
| Rate for Payer: Cigna Commercial |
$1,310.70
|
| Rate for Payer: First Health Commercial |
$1,387.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,387.80
|
| Rate for Payer: GEHA Commercial |
$1,233.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,387.80
|
| Rate for Payer: Humana ChoiceCare |
$400.92
|
| Rate for Payer: Multiplan All |
$1,403.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$925.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,079.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,387.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,464.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,156.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,356.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$385.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,434.06
|
| Rate for Payer: Zelis Auto |
$616.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$771.00
|
|
|
IMPLT ANCHOR SUTURE 5.5
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$616.80 |
| Max. Negotiated Rate |
$1,464.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,233.60
|
| Rate for Payer: Cash Price |
$925.20
|
| Rate for Payer: Cash Price |
$925.20
|
| Rate for Payer: Cigna Commercial |
$1,310.70
|
| Rate for Payer: First Health Commercial |
$1,387.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,387.80
|
| Rate for Payer: GEHA Commercial |
$1,079.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,387.80
|
| Rate for Payer: Multiplan All |
$1,403.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,079.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,387.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,464.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,156.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,434.06
|
| Rate for Payer: Zelis Auto |
$616.80
|
|
|
IMPLT ANCHOR SUTURE 5.5MM
|
Facility
|
OP
|
$1,594.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.50 |
| Max. Negotiated Rate |
$1,514.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$956.40
|
| Rate for Payer: Cash Price |
$956.40
|
| Rate for Payer: Cash Price |
$956.40
|
| Rate for Payer: Cigna Commercial |
$1,354.90
|
| Rate for Payer: First Health Commercial |
$1,434.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,434.60
|
| Rate for Payer: GEHA Commercial |
$1,275.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,434.60
|
| Rate for Payer: Humana ChoiceCare |
$414.44
|
| Rate for Payer: Multiplan All |
$1,450.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$956.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,115.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,434.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,514.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,195.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,402.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$398.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,482.42
|
| Rate for Payer: Zelis Auto |
$637.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$797.00
|
|
|
IMPLT ANCHOR SUTURE 5.5MM
|
Facility
|
IP
|
$1,594.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.60 |
| Max. Negotiated Rate |
$1,514.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,275.20
|
| Rate for Payer: Cash Price |
$956.40
|
| Rate for Payer: Cash Price |
$956.40
|
| Rate for Payer: Cigna Commercial |
$1,354.90
|
| Rate for Payer: First Health Commercial |
$1,434.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,434.60
|
| Rate for Payer: GEHA Commercial |
$1,115.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,434.60
|
| Rate for Payer: Multiplan All |
$1,450.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,115.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,434.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,514.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,195.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,482.42
|
| Rate for Payer: Zelis Auto |
$637.60
|
|
|
IMPLT ANCHOR SUTURE BIOCOMPOSITE 3X12.7
|
Facility
|
OP
|
$2,613.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.25 |
| Max. Negotiated Rate |
$2,482.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cigna Commercial |
$2,221.05
|
| Rate for Payer: First Health Commercial |
$2,351.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,351.70
|
| Rate for Payer: GEHA Commercial |
$2,090.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,351.70
|
| Rate for Payer: Humana ChoiceCare |
$679.38
|
| Rate for Payer: Multiplan All |
$2,377.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,567.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,829.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,351.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,482.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,959.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,299.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$653.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,430.09
|
| Rate for Payer: Zelis Auto |
$1,045.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,306.50
|
|
|
IMPLT ANCHOR SUTURE BIOCOMPOSITE 3X12.7
|
Facility
|
IP
|
$2,613.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,045.20 |
| Max. Negotiated Rate |
$2,482.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,090.40
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cigna Commercial |
$2,221.05
|
| Rate for Payer: First Health Commercial |
$2,351.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,351.70
|
| Rate for Payer: GEHA Commercial |
$1,829.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,351.70
|
| Rate for Payer: Multiplan All |
$2,377.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,829.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,351.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,482.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,959.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,430.09
|
| Rate for Payer: Zelis Auto |
$1,045.20
|
|
|
IMPLT ANCHOR SUTURE BIOCOMPOSITE 3X14.5
|
Facility
|
IP
|
$2,142.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$2,034.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,713.60
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cigna Commercial |
$1,820.70
|
| Rate for Payer: First Health Commercial |
$1,927.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,927.80
|
| Rate for Payer: GEHA Commercial |
$1,499.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,927.80
|
| Rate for Payer: Multiplan All |
$1,949.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,499.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,927.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,034.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,606.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,992.06
|
| Rate for Payer: Zelis Auto |
$856.80
|
|
|
IMPLT ANCHOR SUTURE BIOCOMPOSITE 3X14.5
|
Facility
|
OP
|
$2,142.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.50 |
| Max. Negotiated Rate |
$2,034.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,285.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cigna Commercial |
$1,820.70
|
| Rate for Payer: First Health Commercial |
$1,927.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,927.80
|
| Rate for Payer: GEHA Commercial |
$1,713.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,927.80
|
| Rate for Payer: Humana ChoiceCare |
$556.92
|
| Rate for Payer: Multiplan All |
$1,949.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,285.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,499.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,927.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,034.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,606.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,884.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$535.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,992.06
|
| Rate for Payer: Zelis Auto |
$856.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,071.00
|
|
|
IMPLT ANCHOR SUTURE BIOSTEON 5.5
|
Facility
|
IP
|
$1,862.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$744.80 |
| Max. Negotiated Rate |
$1,768.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,489.60
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$1,582.70
|
| Rate for Payer: First Health Commercial |
$1,675.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,675.80
|
| Rate for Payer: GEHA Commercial |
$1,303.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,675.80
|
| Rate for Payer: Multiplan All |
$1,694.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,303.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,675.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,768.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,396.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,731.66
|
| Rate for Payer: Zelis Auto |
$744.80
|
|
|
IMPLT ANCHOR SUTURE BIOSTEON 5.5
|
Facility
|
OP
|
$1,862.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.50 |
| Max. Negotiated Rate |
$1,768.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,117.20
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$1,582.70
|
| Rate for Payer: First Health Commercial |
$1,675.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,675.80
|
| Rate for Payer: GEHA Commercial |
$1,489.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,675.80
|
| Rate for Payer: Humana ChoiceCare |
$484.12
|
| Rate for Payer: Multiplan All |
$1,694.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,303.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,675.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,768.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,396.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,638.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$465.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,731.66
|
| Rate for Payer: Zelis Auto |
$744.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$931.00
|
|
|
IMPLT ANCHOR SUTURE CORKSCREW 2.2MM
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001811
|
|
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 ANCHOR SUTURE CORKSCREW 2.2MM
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001811
|
|
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 ANCHOR SUTURE CORKSCREW FT LLL
|
Facility
|
IP
|
$1,248.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$1,185.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$998.40
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$1,060.80
|
| Rate for Payer: First Health Commercial |
$1,123.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,123.20
|
| Rate for Payer: GEHA Commercial |
$873.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,123.20
|
| Rate for Payer: Multiplan All |
$1,135.68
|
| Rate for Payer: OMNI Networks Commercial |
$873.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,123.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,185.60
|
| Rate for Payer: Three Rivers Provider Network All |
$936.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,160.64
|
| Rate for Payer: Zelis Auto |
$499.20
|
|
