|
IMPLT ANCHOR SUTURE CORKSCREW FT LLL
|
Facility
|
OP
|
$1,248.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$1,185.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$748.80
|
| 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 |
$998.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,123.20
|
| Rate for Payer: Humana ChoiceCare |
$324.48
|
| Rate for Payer: Multiplan All |
$1,135.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$748.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,098.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$312.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,160.64
|
| Rate for Payer: Zelis Auto |
$499.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$624.00
|
|
|
IMPLT ANCHOR SUTURE PUSHLOCK 2.5X8MM
|
Facility
|
OP
|
$2,329.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.25 |
| Max. Negotiated Rate |
$2,212.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,397.40
|
| Rate for Payer: Cash Price |
$1,397.40
|
| Rate for Payer: Cash Price |
$1,397.40
|
| Rate for Payer: Cigna Commercial |
$1,979.65
|
| Rate for Payer: First Health Commercial |
$2,096.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,096.10
|
| Rate for Payer: GEHA Commercial |
$1,863.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,096.10
|
| Rate for Payer: Humana ChoiceCare |
$605.54
|
| Rate for Payer: Multiplan All |
$2,119.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,397.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,630.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,096.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,212.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,746.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,049.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$582.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,165.97
|
| Rate for Payer: Zelis Auto |
$931.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,164.50
|
|
|
IMPLT ANCHOR SUTURE PUSHLOCK 2.5X8MM
|
Facility
|
IP
|
$2,329.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.60 |
| Max. Negotiated Rate |
$2,212.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,863.20
|
| Rate for Payer: Cash Price |
$1,397.40
|
| Rate for Payer: Cash Price |
$1,397.40
|
| Rate for Payer: Cigna Commercial |
$1,979.65
|
| Rate for Payer: First Health Commercial |
$2,096.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,096.10
|
| Rate for Payer: GEHA Commercial |
$1,630.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,096.10
|
| Rate for Payer: Multiplan All |
$2,119.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,630.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,096.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,212.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,746.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,165.97
|
| Rate for Payer: Zelis Auto |
$931.60
|
|
|
IMPLT ANCHOR SUTURE QFIX 1.8M
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006103
|
|
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 SUTURE QFIX 1.8M
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006103
|
|
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 SUTURE SWIVELOCK 8X19.5MM
|
Facility
|
OP
|
$2,655.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.75 |
| Max. Negotiated Rate |
$2,522.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,593.00
|
| Rate for Payer: Cash Price |
$1,593.00
|
| Rate for Payer: Cash Price |
$1,593.00
|
| Rate for Payer: Cigna Commercial |
$2,256.75
|
| Rate for Payer: First Health Commercial |
$2,389.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,389.50
|
| Rate for Payer: GEHA Commercial |
$2,124.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,389.50
|
| Rate for Payer: Humana ChoiceCare |
$690.30
|
| Rate for Payer: Multiplan All |
$2,416.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,593.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,858.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,389.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,522.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,991.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,336.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$663.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,469.15
|
| Rate for Payer: Zelis Auto |
$1,062.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,327.50
|
|
|
IMPLT ANCHOR SUTURE SWIVELOCK 8X19.5MM
|
Facility
|
IP
|
$2,655.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,062.00 |
| Max. Negotiated Rate |
$2,522.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,124.00
|
| Rate for Payer: Cash Price |
$1,593.00
|
| Rate for Payer: Cash Price |
$1,593.00
|
| Rate for Payer: Cigna Commercial |
$2,256.75
|
| Rate for Payer: First Health Commercial |
$2,389.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,389.50
|
| Rate for Payer: GEHA Commercial |
$1,858.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,389.50
|
| Rate for Payer: Multiplan All |
$2,416.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,858.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,389.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,522.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,991.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,469.15
|
| Rate for Payer: Zelis Auto |
$1,062.00
|
|
|
IMPLT ANCHOR TENDON
|
Facility
|
IP
|
$4,530.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002933
|
|
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 TENDON
|
Facility
|
OP
|
$4,530.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002933
|
|
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 TI SCREW 5MM SIZE2
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.75 |
| Max. Negotiated Rate |
$1,880.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,187.40
|
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cigna Commercial |
$1,682.15
|
| Rate for Payer: First Health Commercial |
$1,781.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,781.10
|
| Rate for Payer: GEHA Commercial |
$1,583.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,781.10
|
| Rate for Payer: Humana ChoiceCare |
$514.54
|
| Rate for Payer: Multiplan All |
$1,800.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,187.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,385.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,781.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,880.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,484.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,741.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$494.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,840.47
|
| Rate for Payer: Zelis Auto |
$791.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$989.50
|
|
|
IMPLT ANCHOR TI SCREW 5MM SIZE2
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$791.60 |
| Max. Negotiated Rate |
$1,880.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,583.20
|
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Cigna Commercial |
$1,682.15
|
| Rate for Payer: First Health Commercial |
$1,781.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,781.10
|
| Rate for Payer: GEHA Commercial |
$1,385.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,781.10
|
| Rate for Payer: Multiplan All |
$1,800.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,385.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,781.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,880.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,484.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,840.47
|
| Rate for Payer: Zelis Auto |
$791.60
|
|
|
IMPLT ANCH SUTRE FTPRINT 4.5
|
Facility
|
OP
|
$1,605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.25 |
| Max. Negotiated Rate |
$1,524.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.00
|
| Rate for Payer: Cash Price |
$963.00
|
| Rate for Payer: Cash Price |
$963.00
|
| Rate for Payer: Cigna Commercial |
$1,364.25
|
| Rate for Payer: First Health Commercial |
$1,444.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,444.50
|
| Rate for Payer: GEHA Commercial |
$1,284.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,444.50
|
| Rate for Payer: Humana ChoiceCare |
$417.30
|
| Rate for Payer: Multiplan All |
$1,460.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$963.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,123.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,444.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,524.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,203.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,412.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$401.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,492.65
|
| Rate for Payer: Zelis Auto |
$642.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$802.50
|
|
|
IMPLT ANCH SUTRE FTPRINT 4.5
|
Facility
|
IP
|
$1,605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.00 |
| Max. Negotiated Rate |
$1,524.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,284.00
|
| Rate for Payer: Cash Price |
$963.00
|
| Rate for Payer: Cash Price |
$963.00
|
| Rate for Payer: Cigna Commercial |
$1,364.25
|
| Rate for Payer: First Health Commercial |
$1,444.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,444.50
|
| Rate for Payer: GEHA Commercial |
$1,123.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,444.50
|
| Rate for Payer: Multiplan All |
$1,460.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,123.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,444.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,524.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,203.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,492.65
|
| Rate for Payer: Zelis Auto |
$642.00
|
|
|
IMPLT ANCH SUTRE FTPRINT 4.5 TEMP #
|
Facility
|
IP
|
$1,594.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000332
|
|
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 ANCH SUTRE FTPRINT 4.5 TEMP #
|
Facility
|
OP
|
$1,594.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000332
|
|
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 ANCH SUTURE KNOTLESS
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.40 |
| Max. Negotiated Rate |
$1,364.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,148.80
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cigna Commercial |
$1,220.60
|
| Rate for Payer: First Health Commercial |
$1,292.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,292.40
|
| Rate for Payer: GEHA Commercial |
$1,005.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,292.40
|
| Rate for Payer: Multiplan All |
$1,306.76
|
| Rate for Payer: OMNI Networks Commercial |
$1,005.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,292.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,364.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,077.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,335.48
|
| Rate for Payer: Zelis Auto |
$574.40
|
|
|
IMPLT ANCH SUTURE KNOTLESS
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.00 |
| Max. Negotiated Rate |
$1,364.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cigna Commercial |
$1,220.60
|
| Rate for Payer: First Health Commercial |
$1,292.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,292.40
|
| Rate for Payer: GEHA Commercial |
$1,148.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,292.40
|
| Rate for Payer: Humana ChoiceCare |
$373.36
|
| Rate for Payer: Multiplan All |
$1,306.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$861.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,005.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,292.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,364.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,077.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,263.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$359.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,335.48
|
| Rate for Payer: Zelis Auto |
$574.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$718.00
|
|
|
IMPLT ANTENNA NEUROSTIMULATOR
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
7002398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$446.40
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
|
|
IMPLT ANTENNA NEUROSTIMULATOR
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
7002398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
|
|
IMPLT APPLIER CLIP ENDOSCOPIC 5MM
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7002499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.60 |
| Max. Negotiated Rate |
$2,397.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,019.20
|
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Cigna Commercial |
$2,145.40
|
| Rate for Payer: First Health Commercial |
$2,271.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,271.60
|
| Rate for Payer: GEHA Commercial |
$1,766.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,271.60
|
| Rate for Payer: Multiplan All |
$2,296.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,766.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,271.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,397.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,893.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,347.32
|
| Rate for Payer: Zelis Auto |
$1,009.60
|
|
|
IMPLT APPLIER CLIP ENDOSCOPIC 5MM
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7002499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.00 |
| Max. Negotiated Rate |
$2,397.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,514.40
|
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Cigna Commercial |
$2,145.40
|
| Rate for Payer: First Health Commercial |
$2,271.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,271.60
|
| Rate for Payer: GEHA Commercial |
$2,019.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,271.60
|
| Rate for Payer: Humana ChoiceCare |
$656.24
|
| Rate for Payer: Multiplan All |
$2,296.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,514.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,766.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,271.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,397.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,893.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,221.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$631.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,347.32
|
| Rate for Payer: Zelis Auto |
$1,009.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,262.00
|
|
|
IMPLT APPLIGRAF UNIT 1 SKIN GRAFT
|
Facility
|
OP
|
$5,011.00
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
7002459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$4,760.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$45.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,006.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$45.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.22
|
| Rate for Payer: Cash Price |
$3,006.60
|
| Rate for Payer: Cash Price |
$3,006.60
|
| Rate for Payer: Cash Price |
$3,006.60
|
| Rate for Payer: Cigna Commercial |
$4,259.35
|
| Rate for Payer: First Health Commercial |
$4,509.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,509.90
|
| Rate for Payer: GEHA Commercial |
$33.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,509.90
|
| Rate for Payer: Humana ChoiceCare |
$1,302.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$36.96
|
| Rate for Payer: Multiplan All |
$4,560.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,006.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,507.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,509.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$42.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$36.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,760.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,758.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,409.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,660.23
|
| Rate for Payer: Zelis Auto |
$2,004.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,505.50
|
|
|
IMPLT APPLIGRAF UNIT 1 SKIN GRAFT
|
Facility
|
IP
|
$5,011.00
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
7002459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,004.40 |
| Max. Negotiated Rate |
$4,760.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,008.80
|
| Rate for Payer: Cash Price |
$3,006.60
|
| Rate for Payer: Cash Price |
$3,006.60
|
| Rate for Payer: Cigna Commercial |
$4,259.35
|
| Rate for Payer: First Health Commercial |
$4,509.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,509.90
|
| Rate for Payer: GEHA Commercial |
$3,507.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,509.90
|
| Rate for Payer: Multiplan All |
$4,560.01
|
| Rate for Payer: OMNI Networks Commercial |
$3,507.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,509.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,760.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,758.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,660.23
|
| Rate for Payer: Zelis Auto |
$2,004.40
|
|
|
IMPLT ASSEMBLY FX HFMN2 MIC LNTHNR
|
Facility
|
OP
|
$8,201.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,050.25 |
| Max. Negotiated Rate |
$7,790.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,920.60
|
| Rate for Payer: Cash Price |
$4,920.60
|
| Rate for Payer: Cash Price |
$4,920.60
|
| Rate for Payer: Cigna Commercial |
$6,970.85
|
| Rate for Payer: First Health Commercial |
$7,380.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,380.90
|
| Rate for Payer: GEHA Commercial |
$6,560.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,380.90
|
| Rate for Payer: Humana ChoiceCare |
$2,132.26
|
| Rate for Payer: Multiplan All |
$7,462.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,920.60
|
| Rate for Payer: OMNI Networks Commercial |
$5,740.70
|
| Rate for Payer: One Health Plan PPO/POS |
$7,380.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,790.95
|
| Rate for Payer: Three Rivers Provider Network All |
$6,150.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,216.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,050.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,626.93
|
| Rate for Payer: Zelis Auto |
$3,280.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,100.50
|
|
|
IMPLT ASSEMBLY FX HFMN2 MIC LNTHNR
|
Facility
|
IP
|
$8,201.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,280.40 |
| Max. Negotiated Rate |
$7,790.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,560.80
|
| Rate for Payer: Cash Price |
$4,920.60
|
| Rate for Payer: Cash Price |
$4,920.60
|
| Rate for Payer: Cigna Commercial |
$6,970.85
|
| Rate for Payer: First Health Commercial |
$7,380.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,380.90
|
| Rate for Payer: GEHA Commercial |
$5,740.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,380.90
|
| Rate for Payer: Multiplan All |
$7,462.91
|
| Rate for Payer: OMNI Networks Commercial |
$5,740.70
|
| Rate for Payer: One Health Plan PPO/POS |
$7,380.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,790.95
|
| Rate for Payer: Three Rivers Provider Network All |
$6,150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,626.93
|
| Rate for Payer: Zelis Auto |
$3,280.40
|
|
