|
IMPLT BONE SCREW HW 16MM 1152-16
|
Facility
|
IP
|
$2,159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.60 |
| Max. Negotiated Rate |
$2,051.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,727.20
|
| Rate for Payer: Cash Price |
$1,295.40
|
| Rate for Payer: Cash Price |
$1,295.40
|
| Rate for Payer: Cigna Commercial |
$1,835.15
|
| Rate for Payer: First Health Commercial |
$1,943.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,943.10
|
| Rate for Payer: GEHA Commercial |
$1,511.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,943.10
|
| Rate for Payer: Multiplan All |
$1,964.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,511.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,943.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,051.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,619.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,007.87
|
| Rate for Payer: Zelis Auto |
$863.60
|
|
|
IMPLT BONE SUBSTITUTE VITOSS 15CC
|
Facility
|
OP
|
$4,686.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,171.50 |
| Max. Negotiated Rate |
$4,451.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna Commercial |
$3,983.10
|
| Rate for Payer: First Health Commercial |
$4,217.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,217.40
|
| Rate for Payer: GEHA Commercial |
$3,748.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,217.40
|
| Rate for Payer: Humana ChoiceCare |
$1,218.36
|
| Rate for Payer: Multiplan All |
$4,264.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,811.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,280.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,217.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,451.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,514.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,123.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,171.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,357.98
|
| Rate for Payer: Zelis Auto |
$1,874.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,343.00
|
|
|
IMPLT BONE SUBSTITUTE VITOSS 15CC
|
Facility
|
IP
|
$4,686.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,874.40 |
| Max. Negotiated Rate |
$4,451.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,748.80
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cash Price |
$2,811.60
|
| Rate for Payer: Cigna Commercial |
$3,983.10
|
| Rate for Payer: First Health Commercial |
$4,217.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,217.40
|
| Rate for Payer: GEHA Commercial |
$3,280.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,217.40
|
| Rate for Payer: Multiplan All |
$4,264.26
|
| Rate for Payer: OMNI Networks Commercial |
$3,280.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,217.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,451.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,514.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,357.98
|
| Rate for Payer: Zelis Auto |
$1,874.40
|
|
|
IMPLT BRG STBLZD ANT VNGD 12X75
|
Facility
|
OP
|
$3,806.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$951.50 |
| Max. Negotiated Rate |
$3,615.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cigna Commercial |
$3,235.10
|
| Rate for Payer: First Health Commercial |
$3,425.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,425.40
|
| Rate for Payer: GEHA Commercial |
$3,044.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,425.40
|
| Rate for Payer: Humana ChoiceCare |
$989.56
|
| Rate for Payer: Multiplan All |
$3,463.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,283.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,664.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,425.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,615.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,854.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,349.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$951.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,539.58
|
| Rate for Payer: Zelis Auto |
$1,522.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,903.00
|
|
|
IMPLT BRG STBLZD ANT VNGD 12X75
|
Facility
|
IP
|
$3,806.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,522.40 |
| Max. Negotiated Rate |
$3,615.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,044.80
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cigna Commercial |
$3,235.10
|
| Rate for Payer: First Health Commercial |
$3,425.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,425.40
|
| Rate for Payer: GEHA Commercial |
$2,664.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,425.40
|
| Rate for Payer: Multiplan All |
$3,463.46
|
| Rate for Payer: OMNI Networks Commercial |
$2,664.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,425.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,615.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,854.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,539.58
|
| Rate for Payer: Zelis Auto |
$1,522.40
|
|
|
IMPLT BUSHING FEMORAL KNEE MRH
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.40 |
| Max. Negotiated Rate |
$1,202.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,012.80
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,076.10
|
| Rate for Payer: First Health Commercial |
$1,139.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,139.40
|
| Rate for Payer: GEHA Commercial |
$886.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,139.40
|
| Rate for Payer: Multiplan All |
$1,152.06
|
| Rate for Payer: OMNI Networks Commercial |
$886.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,139.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,202.70
|
| Rate for Payer: Three Rivers Provider Network All |
$949.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,177.38
|
| Rate for Payer: Zelis Auto |
$506.40
|
|
|
IMPLT BUSHING FEMORAL KNEE MRH
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.50 |
| Max. Negotiated Rate |
$1,202.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,076.10
|
| Rate for Payer: First Health Commercial |
$1,139.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,139.40
|
| Rate for Payer: GEHA Commercial |
$1,012.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,139.40
|
| Rate for Payer: Humana ChoiceCare |
$329.16
|
| Rate for Payer: Multiplan All |
$1,152.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$759.60
|
| Rate for Payer: OMNI Networks Commercial |
$886.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,139.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,202.70
|
| Rate for Payer: Three Rivers Provider Network All |
$949.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,114.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$316.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,177.38
|
| Rate for Payer: Zelis Auto |
$506.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$633.00
|
|
|
IMPLT BUTTON SEPTAL SILICONE
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT D5922
|
| Hospital Charge Code |
7006508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$66.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Humana ChoiceCare |
$21.58
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.80
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$73.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.50
|
|
|
IMPLT BUTTON SEPTAL SILICONE
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT D5922
|
| Hospital Charge Code |
7006508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.40
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$58.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: Zelis Auto |
$33.20
|
|
|
IMPLT CANCELLOUS SCREW
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$349.60
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$393.30
|
| Rate for Payer: GEHA Commercial |
$305.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$393.30
|
| Rate for Payer: Multiplan All |
$397.67
|
| Rate for Payer: OMNI Networks Commercial |
$305.90
|
| Rate for Payer: One Health Plan PPO/POS |
$393.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$415.15
|
| Rate for Payer: Three Rivers Provider Network All |
$327.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$406.41
|
| Rate for Payer: Zelis Auto |
$174.80
|
|
|
IMPLT CANCELLOUS SCREW
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.25 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$262.20
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$393.30
|
| Rate for Payer: GEHA Commercial |
$349.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$393.30
|
| Rate for Payer: Humana ChoiceCare |
$113.62
|
| Rate for Payer: Multiplan All |
$397.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$262.20
|
| Rate for Payer: OMNI Networks Commercial |
$305.90
|
| Rate for Payer: One Health Plan PPO/POS |
$393.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$415.15
|
| Rate for Payer: Three Rivers Provider Network All |
$327.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$384.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$109.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$406.41
|
| Rate for Payer: Zelis Auto |
$174.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$218.50
|
|
|
IMPLT CANNULATED SCREW 3.5 205.040
|
Facility
|
OP
|
$1,216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: First Health Commercial |
$1,094.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,094.40
|
| Rate for Payer: GEHA Commercial |
$972.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,094.40
|
| Rate for Payer: Humana ChoiceCare |
$316.16
|
| Rate for Payer: Multiplan All |
$1,106.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$729.60
|
| Rate for Payer: OMNI Networks Commercial |
$851.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,094.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,155.20
|
| Rate for Payer: Three Rivers Provider Network All |
$912.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,070.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,130.88
|
| Rate for Payer: Zelis Auto |
$486.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$608.00
|
|
|
IMPLT CANNULATED SCREW 3.5 205.040
|
Facility
|
IP
|
$1,216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.40 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$972.80
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: First Health Commercial |
$1,094.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,094.40
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,094.40
|
| Rate for Payer: Multiplan All |
$1,106.56
|
| Rate for Payer: OMNI Networks Commercial |
$851.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,094.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,155.20
|
| Rate for Payer: Three Rivers Provider Network All |
$912.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,130.88
|
| Rate for Payer: Zelis Auto |
$486.40
|
|
|
IMPLT CAP END 10MM PLUS
|
Facility
|
IP
|
$981.00
|
|
| Hospital Charge Code |
90061622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.40 |
| Max. Negotiated Rate |
$931.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$784.80
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cigna Commercial |
$833.85
|
| Rate for Payer: First Health Commercial |
$882.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$882.90
|
| Rate for Payer: GEHA Commercial |
$686.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$882.90
|
| Rate for Payer: Multiplan All |
$892.71
|
| Rate for Payer: OMNI Networks Commercial |
$686.70
|
| Rate for Payer: One Health Plan PPO/POS |
$882.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$931.95
|
| Rate for Payer: Three Rivers Provider Network All |
$735.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$912.33
|
| Rate for Payer: Zelis Auto |
$392.40
|
|
|
IMPLT CAP END 10MM PLUS
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.40 |
| Max. Negotiated Rate |
$931.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$784.80
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cigna Commercial |
$833.85
|
| Rate for Payer: First Health Commercial |
$882.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$882.90
|
| Rate for Payer: GEHA Commercial |
$686.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$882.90
|
| Rate for Payer: Multiplan All |
$892.71
|
| Rate for Payer: OMNI Networks Commercial |
$686.70
|
| Rate for Payer: One Health Plan PPO/POS |
$882.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$931.95
|
| Rate for Payer: Three Rivers Provider Network All |
$735.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$912.33
|
| Rate for Payer: Zelis Auto |
$392.40
|
|
|
IMPLT CAP END 10MM PLUS
|
Facility
|
OP
|
$981.00
|
|
| Hospital Charge Code |
90061622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.25 |
| Max. Negotiated Rate |
$931.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cigna Commercial |
$833.85
|
| Rate for Payer: First Health Commercial |
$882.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$882.90
|
| Rate for Payer: GEHA Commercial |
$784.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$882.90
|
| Rate for Payer: Humana ChoiceCare |
$255.06
|
| Rate for Payer: Multiplan All |
$892.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.60
|
| Rate for Payer: OMNI Networks Commercial |
$686.70
|
| Rate for Payer: One Health Plan PPO/POS |
$882.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$931.95
|
| Rate for Payer: Three Rivers Provider Network All |
$735.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$863.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$245.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$912.33
|
| Rate for Payer: Zelis Auto |
$392.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$490.50
|
|
|
IMPLT CAP END 10MM PLUS
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.25 |
| Max. Negotiated Rate |
$931.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cigna Commercial |
$833.85
|
| Rate for Payer: First Health Commercial |
$882.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$882.90
|
| Rate for Payer: GEHA Commercial |
$784.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$882.90
|
| Rate for Payer: Humana ChoiceCare |
$255.06
|
| Rate for Payer: Multiplan All |
$892.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.60
|
| Rate for Payer: OMNI Networks Commercial |
$686.70
|
| Rate for Payer: One Health Plan PPO/POS |
$882.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$931.95
|
| Rate for Payer: Three Rivers Provider Network All |
$735.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$863.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$245.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$912.33
|
| Rate for Payer: Zelis Auto |
$392.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$490.50
|
|
|
IMPLT CAP END +15MM
|
Facility
|
IP
|
$883.00
|
|
| Hospital Charge Code |
7003071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.20 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$706.40
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$750.55
|
| Rate for Payer: First Health Commercial |
$794.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$794.70
|
| Rate for Payer: GEHA Commercial |
$618.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$794.70
|
| Rate for Payer: Multiplan All |
$803.53
|
| Rate for Payer: OMNI Networks Commercial |
$618.10
|
| Rate for Payer: One Health Plan PPO/POS |
$794.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$838.85
|
| Rate for Payer: Three Rivers Provider Network All |
$662.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$821.19
|
| Rate for Payer: Zelis Auto |
$353.20
|
|
|
IMPLT CAP END +15MM
|
Facility
|
OP
|
$883.00
|
|
| Hospital Charge Code |
7003071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.75 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$750.55
|
| Rate for Payer: First Health Commercial |
$794.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$794.70
|
| Rate for Payer: GEHA Commercial |
$706.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$794.70
|
| Rate for Payer: Humana ChoiceCare |
$229.58
|
| Rate for Payer: Multiplan All |
$803.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$529.80
|
| Rate for Payer: OMNI Networks Commercial |
$618.10
|
| Rate for Payer: One Health Plan PPO/POS |
$794.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$838.85
|
| Rate for Payer: Three Rivers Provider Network All |
$662.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$777.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$821.19
|
| Rate for Payer: Zelis Auto |
$353.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$441.50
|
|
|
IMPLT CAP END +5MM
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.75 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$750.55
|
| Rate for Payer: First Health Commercial |
$794.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$794.70
|
| Rate for Payer: GEHA Commercial |
$706.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$794.70
|
| Rate for Payer: Humana ChoiceCare |
$229.58
|
| Rate for Payer: Multiplan All |
$803.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$529.80
|
| Rate for Payer: OMNI Networks Commercial |
$618.10
|
| Rate for Payer: One Health Plan PPO/POS |
$794.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$838.85
|
| Rate for Payer: Three Rivers Provider Network All |
$662.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$777.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$821.19
|
| Rate for Payer: Zelis Auto |
$353.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$441.50
|
|
|
IMPLT CAP END +5MM
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.20 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$706.40
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$750.55
|
| Rate for Payer: First Health Commercial |
$794.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$794.70
|
| Rate for Payer: GEHA Commercial |
$618.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$794.70
|
| Rate for Payer: Multiplan All |
$803.53
|
| Rate for Payer: OMNI Networks Commercial |
$618.10
|
| Rate for Payer: One Health Plan PPO/POS |
$794.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$838.85
|
| Rate for Payer: Three Rivers Provider Network All |
$662.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$821.19
|
| Rate for Payer: Zelis Auto |
$353.20
|
|
|
IMPLT CAP END FEMORAL
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.50 |
| Max. Negotiated Rate |
$879.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$555.60
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$740.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| Rate for Payer: Humana ChoiceCare |
$240.76
|
| Rate for Payer: Multiplan All |
$842.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$555.60
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$879.70
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$814.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$231.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$861.18
|
| Rate for Payer: Zelis Auto |
$370.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$463.00
|
|
|
IMPLT CAP END FEMORAL
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$370.40 |
| Max. Negotiated Rate |
$879.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$740.80
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$648.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| Rate for Payer: Multiplan All |
$842.66
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$879.70
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$861.18
|
| Rate for Payer: Zelis Auto |
$370.40
|
|
|
IMPLT CAP END THREADED FULLY
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.60 |
| Max. Negotiated Rate |
$854.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$719.20
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cigna Commercial |
$764.15
|
| Rate for Payer: First Health Commercial |
$809.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$809.10
|
| Rate for Payer: GEHA Commercial |
$629.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$809.10
|
| Rate for Payer: Multiplan All |
$818.09
|
| Rate for Payer: OMNI Networks Commercial |
$629.30
|
| Rate for Payer: One Health Plan PPO/POS |
$809.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$854.05
|
| Rate for Payer: Three Rivers Provider Network All |
$674.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$836.07
|
| Rate for Payer: Zelis Auto |
$359.60
|
|
|
IMPLT CAP END THREADED FULLY
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.75 |
| Max. Negotiated Rate |
$854.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cigna Commercial |
$764.15
|
| Rate for Payer: First Health Commercial |
$809.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$809.10
|
| Rate for Payer: GEHA Commercial |
$719.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$809.10
|
| Rate for Payer: Humana ChoiceCare |
$233.74
|
| Rate for Payer: Multiplan All |
$818.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$539.40
|
| Rate for Payer: OMNI Networks Commercial |
$629.30
|
| Rate for Payer: One Health Plan PPO/POS |
$809.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$854.05
|
| Rate for Payer: Three Rivers Provider Network All |
$674.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$791.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$836.07
|
| Rate for Payer: Zelis Auto |
$359.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.50
|
|
