|
IMPLT CATH URETERAL FLEX TIP 6FRX70CM
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT C1758
|
| Hospital Charge Code |
7001696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.80 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$513.60
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cigna Commercial |
$545.70
|
| Rate for Payer: First Health Commercial |
$577.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$577.80
|
| Rate for Payer: GEHA Commercial |
$449.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$577.80
|
| Rate for Payer: Multiplan All |
$584.22
|
| Rate for Payer: OMNI Networks Commercial |
$449.40
|
| Rate for Payer: One Health Plan PPO/POS |
$577.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$609.90
|
| Rate for Payer: Three Rivers Provider Network All |
$481.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$597.06
|
| Rate for Payer: Zelis Auto |
$256.80
|
|
|
IMPLT CBL 2.0 ALLOY VITALIUM
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,282.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,080.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,147.50
|
| Rate for Payer: First Health Commercial |
$1,215.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,215.00
|
| Rate for Payer: GEHA Commercial |
$945.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,215.00
|
| Rate for Payer: Multiplan All |
$1,228.50
|
| Rate for Payer: OMNI Networks Commercial |
$945.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,215.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,282.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,012.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,255.50
|
| Rate for Payer: Zelis Auto |
$540.00
|
|
|
IMPLT CBL 2.0 ALLOY VITALIUM
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,282.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,147.50
|
| Rate for Payer: First Health Commercial |
$1,215.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,215.00
|
| Rate for Payer: GEHA Commercial |
$1,080.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,215.00
|
| Rate for Payer: Humana ChoiceCare |
$351.00
|
| Rate for Payer: Multiplan All |
$1,228.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$810.00
|
| Rate for Payer: OMNI Networks Commercial |
$945.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,215.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,282.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,012.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,188.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$337.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,255.50
|
| Rate for Payer: Zelis Auto |
$540.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$675.00
|
|
|
IMPLT CBL 2.0MM ALLOY BEADED
|
Facility
|
OP
|
$1,555.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$388.75 |
| Max. Negotiated Rate |
$1,477.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$933.00
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cigna Commercial |
$1,321.75
|
| Rate for Payer: First Health Commercial |
$1,399.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,399.50
|
| Rate for Payer: GEHA Commercial |
$1,244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,399.50
|
| Rate for Payer: Humana ChoiceCare |
$404.30
|
| Rate for Payer: Multiplan All |
$1,415.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$933.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,088.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,399.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,477.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,166.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,368.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$388.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,446.15
|
| Rate for Payer: Zelis Auto |
$622.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$777.50
|
|
|
IMPLT CBL 2.0MM ALLOY BEADED
|
Facility
|
IP
|
$1,555.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.00 |
| Max. Negotiated Rate |
$1,477.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,244.00
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cigna Commercial |
$1,321.75
|
| Rate for Payer: First Health Commercial |
$1,399.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,399.50
|
| Rate for Payer: GEHA Commercial |
$1,088.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,399.50
|
| Rate for Payer: Multiplan All |
$1,415.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,088.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,399.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,477.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,166.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,446.15
|
| Rate for Payer: Zelis Auto |
$622.00
|
|
|
IMPLT CBL 2.0MM CABLE
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$323.25 |
| Max. Negotiated Rate |
$1,228.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$1,099.05
|
| Rate for Payer: First Health Commercial |
$1,163.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,163.70
|
| Rate for Payer: GEHA Commercial |
$1,034.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,163.70
|
| Rate for Payer: Humana ChoiceCare |
$336.18
|
| Rate for Payer: Multiplan All |
$1,176.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$775.80
|
| Rate for Payer: OMNI Networks Commercial |
$905.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,163.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,228.35
|
| Rate for Payer: Three Rivers Provider Network All |
$969.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,137.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,202.49
|
| Rate for Payer: Zelis Auto |
$517.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$646.50
|
|
|
IMPLT CBL 2.0MM CABLE
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.20 |
| Max. Negotiated Rate |
$1,228.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,034.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$1,099.05
|
| Rate for Payer: First Health Commercial |
$1,163.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,163.70
|
| Rate for Payer: GEHA Commercial |
$905.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,163.70
|
| Rate for Payer: Multiplan All |
$1,176.63
|
| Rate for Payer: OMNI Networks Commercial |
$905.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,163.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,228.35
|
| Rate for Payer: Three Rivers Provider Network All |
$969.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,202.49
|
| Rate for Payer: Zelis Auto |
$517.20
|
|
|
IMPLT CEMENT BONE HYDROXYLAPATITE
|
Facility
|
OP
|
$1,926.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000266
|
|
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 CEMENT BONE HYDROXYLAPATITE
|
Facility
|
IP
|
$1,926.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000266
|
|
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 CEMENT COBALT HV-GENTAMICIN
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$846.80 |
| Max. Negotiated Rate |
$2,011.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,693.60
|
| Rate for Payer: Cash Price |
$1,270.20
|
| Rate for Payer: Cash Price |
$1,270.20
|
| Rate for Payer: Cigna Commercial |
$1,799.45
|
| Rate for Payer: First Health Commercial |
$1,905.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,905.30
|
| Rate for Payer: GEHA Commercial |
$1,481.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,905.30
|
| Rate for Payer: Multiplan All |
$1,926.47
|
| Rate for Payer: OMNI Networks Commercial |
$1,481.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,905.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,011.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,587.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,968.81
|
| Rate for Payer: Zelis Auto |
$846.80
|
|
|
IMPLT CEMENT COBALT HV-GENTAMICIN
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.25 |
| Max. Negotiated Rate |
$2,011.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,270.20
|
| Rate for Payer: Cash Price |
$1,270.20
|
| Rate for Payer: Cash Price |
$1,270.20
|
| Rate for Payer: Cigna Commercial |
$1,799.45
|
| Rate for Payer: First Health Commercial |
$1,905.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,905.30
|
| Rate for Payer: GEHA Commercial |
$1,693.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,905.30
|
| Rate for Payer: Humana ChoiceCare |
$550.42
|
| Rate for Payer: Multiplan All |
$1,926.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,270.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,481.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,905.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,011.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,587.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,862.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$529.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,968.81
|
| Rate for Payer: Zelis Auto |
$846.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,058.50
|
|
|
IMPLT CEMENT KYPHON XPEDE
|
Facility
|
IP
|
$1,123.48
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7004281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$449.39 |
| Max. Negotiated Rate |
$1,067.31 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$898.78
|
| Rate for Payer: Cash Price |
$674.09
|
| Rate for Payer: Cash Price |
$674.09
|
| Rate for Payer: Cigna Commercial |
$954.96
|
| Rate for Payer: First Health Commercial |
$1,011.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,011.13
|
| Rate for Payer: GEHA Commercial |
$786.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,011.13
|
| Rate for Payer: Multiplan All |
$1,022.37
|
| Rate for Payer: OMNI Networks Commercial |
$786.44
|
| Rate for Payer: One Health Plan PPO/POS |
$1,011.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,067.31
|
| Rate for Payer: Three Rivers Provider Network All |
$842.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,044.84
|
| Rate for Payer: Zelis Auto |
$449.39
|
|
|
IMPLT CEMENT KYPHON XPEDE
|
Facility
|
OP
|
$1,123.48
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7004281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.87 |
| Max. Negotiated Rate |
$1,067.31 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$674.09
|
| Rate for Payer: Cash Price |
$674.09
|
| Rate for Payer: Cash Price |
$674.09
|
| Rate for Payer: Cigna Commercial |
$954.96
|
| Rate for Payer: First Health Commercial |
$1,011.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,011.13
|
| Rate for Payer: GEHA Commercial |
$898.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,011.13
|
| Rate for Payer: Humana ChoiceCare |
$292.10
|
| Rate for Payer: Multiplan All |
$1,022.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$674.09
|
| Rate for Payer: OMNI Networks Commercial |
$786.44
|
| Rate for Payer: One Health Plan PPO/POS |
$1,011.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,067.31
|
| Rate for Payer: Three Rivers Provider Network All |
$842.61
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$988.66
|
| Rate for Payer: United Healthcare Managed Medicaid |
$280.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,044.84
|
| Rate for Payer: Zelis Auto |
$449.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$561.74
|
|
|
IMPLT CEMENT RADIOPAQUE BONE
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000019
|
|
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 CEMENT RADIOPAQUE BONE
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000019
|
|
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 CEMENT SIMPLEX GENTAMICIN
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.80 |
| Max. Negotiated Rate |
$875.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$737.60
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$783.70
|
| Rate for Payer: First Health Commercial |
$829.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$829.80
|
| Rate for Payer: GEHA Commercial |
$645.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$829.80
|
| Rate for Payer: Multiplan All |
$839.02
|
| Rate for Payer: OMNI Networks Commercial |
$645.40
|
| Rate for Payer: One Health Plan PPO/POS |
$829.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$875.90
|
| Rate for Payer: Three Rivers Provider Network All |
$691.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$857.46
|
| Rate for Payer: Zelis Auto |
$368.80
|
|
|
IMPLT CEMENT SIMPLEX GENTAMICIN
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.50 |
| Max. Negotiated Rate |
$875.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$783.70
|
| Rate for Payer: First Health Commercial |
$829.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$829.80
|
| Rate for Payer: GEHA Commercial |
$737.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$829.80
|
| Rate for Payer: Humana ChoiceCare |
$239.72
|
| Rate for Payer: Multiplan All |
$839.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$553.20
|
| Rate for Payer: OMNI Networks Commercial |
$645.40
|
| Rate for Payer: One Health Plan PPO/POS |
$829.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$875.90
|
| Rate for Payer: Three Rivers Provider Network All |
$691.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$811.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$230.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$857.46
|
| Rate for Payer: Zelis Auto |
$368.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$461.00
|
|
|
IMPLT CEMENT SIMPLEX W/GENT
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$356.80
|
| Rate for Payer: Cash Price |
$267.60
|
| Rate for Payer: Cash Price |
$267.60
|
| Rate for Payer: Cigna Commercial |
$379.10
|
| Rate for Payer: First Health Commercial |
$401.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$401.40
|
| Rate for Payer: GEHA Commercial |
$312.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$401.40
|
| Rate for Payer: Multiplan All |
$405.86
|
| Rate for Payer: OMNI Networks Commercial |
$312.20
|
| Rate for Payer: One Health Plan PPO/POS |
$401.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$423.70
|
| Rate for Payer: Three Rivers Provider Network All |
$334.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$414.78
|
| Rate for Payer: Zelis Auto |
$178.40
|
|
|
IMPLT CEMENT SIMPLEX W/GENT
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.50 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$267.60
|
| Rate for Payer: Cash Price |
$267.60
|
| Rate for Payer: Cash Price |
$267.60
|
| Rate for Payer: Cigna Commercial |
$379.10
|
| Rate for Payer: First Health Commercial |
$401.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$401.40
|
| Rate for Payer: GEHA Commercial |
$356.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$401.40
|
| Rate for Payer: Humana ChoiceCare |
$115.96
|
| Rate for Payer: Multiplan All |
$405.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$267.60
|
| Rate for Payer: OMNI Networks Commercial |
$312.20
|
| Rate for Payer: One Health Plan PPO/POS |
$401.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$423.70
|
| Rate for Payer: Three Rivers Provider Network All |
$334.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$392.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$414.78
|
| Rate for Payer: Zelis Auto |
$178.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$223.00
|
|
|
IMPLT CEMENT SIMPLEX W/TOBRAMYCIN
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Humana ChoiceCare |
$340.34
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$785.40
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,151.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$327.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$654.50
|
|
|
IMPLT CEMENT SIMPLEX W/TOBRAMYCIN
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,047.20
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
|
|
IMPLT CEMENT SZ11 STANDARD FEMUR
|
Facility
|
OP
|
$26,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,600.00 |
| Max. Negotiated Rate |
$25,080.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15,840.00
|
| Rate for Payer: Cash Price |
$15,840.00
|
| Rate for Payer: Cash Price |
$15,840.00
|
| Rate for Payer: Cigna Commercial |
$22,440.00
|
| Rate for Payer: First Health Commercial |
$23,760.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$23,760.00
|
| Rate for Payer: GEHA Commercial |
$21,120.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$23,760.00
|
| Rate for Payer: Humana ChoiceCare |
$6,864.00
|
| Rate for Payer: Multiplan All |
$24,024.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15,840.00
|
| Rate for Payer: OMNI Networks Commercial |
$18,480.00
|
| Rate for Payer: One Health Plan PPO/POS |
$23,760.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$25,080.00
|
| Rate for Payer: Three Rivers Provider Network All |
$19,800.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23,232.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,600.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$24,552.00
|
| Rate for Payer: Zelis Auto |
$10,560.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13,200.00
|
|
|
IMPLT CEMENT SZ11 STANDARD FEMUR
|
Facility
|
IP
|
$26,400.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,560.00 |
| Max. Negotiated Rate |
$25,080.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21,120.00
|
| Rate for Payer: Cash Price |
$15,840.00
|
| Rate for Payer: Cash Price |
$15,840.00
|
| Rate for Payer: Cigna Commercial |
$22,440.00
|
| Rate for Payer: First Health Commercial |
$23,760.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$23,760.00
|
| Rate for Payer: GEHA Commercial |
$18,480.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$23,760.00
|
| Rate for Payer: Multiplan All |
$24,024.00
|
| Rate for Payer: OMNI Networks Commercial |
$18,480.00
|
| Rate for Payer: One Health Plan PPO/POS |
$23,760.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$25,080.00
|
| Rate for Payer: Three Rivers Provider Network All |
$19,800.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$24,552.00
|
| Rate for Payer: Zelis Auto |
$10,560.00
|
|
|
IMPLT CENTRALIZER DISTAL 13MM
|
Facility
|
IP
|
$1,066.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.40 |
| Max. Negotiated Rate |
$1,012.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$852.80
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cigna Commercial |
$906.10
|
| Rate for Payer: First Health Commercial |
$959.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$959.40
|
| Rate for Payer: GEHA Commercial |
$746.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$959.40
|
| Rate for Payer: Multiplan All |
$970.06
|
| Rate for Payer: OMNI Networks Commercial |
$746.20
|
| Rate for Payer: One Health Plan PPO/POS |
$959.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,012.70
|
| Rate for Payer: Three Rivers Provider Network All |
$799.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$991.38
|
| Rate for Payer: Zelis Auto |
$426.40
|
|
|
IMPLT CENTRALIZER DISTAL 13MM
|
Facility
|
OP
|
$1,066.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,012.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$639.60
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cigna Commercial |
$906.10
|
| Rate for Payer: First Health Commercial |
$959.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$959.40
|
| Rate for Payer: GEHA Commercial |
$852.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$959.40
|
| Rate for Payer: Humana ChoiceCare |
$277.16
|
| Rate for Payer: Multiplan All |
$970.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$639.60
|
| Rate for Payer: OMNI Networks Commercial |
$746.20
|
| Rate for Payer: One Health Plan PPO/POS |
$959.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,012.70
|
| Rate for Payer: Three Rivers Provider Network All |
$799.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$938.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$991.38
|
| Rate for Payer: Zelis Auto |
$426.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$533.00
|
|
