|
IMPLT CENTRALIZER DISTAL 13MM
|
Facility
|
OP
|
$12,585.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,146.25 |
| Max. Negotiated Rate |
$11,955.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,551.00
|
| Rate for Payer: Cash Price |
$7,551.00
|
| Rate for Payer: Cash Price |
$7,551.00
|
| Rate for Payer: Cigna Commercial |
$10,697.25
|
| Rate for Payer: First Health Commercial |
$11,326.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11,326.50
|
| Rate for Payer: GEHA Commercial |
$10,068.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11,326.50
|
| Rate for Payer: Humana ChoiceCare |
$3,272.10
|
| Rate for Payer: Multiplan All |
$11,452.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,551.00
|
| Rate for Payer: OMNI Networks Commercial |
$8,809.50
|
| Rate for Payer: One Health Plan PPO/POS |
$11,326.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,955.75
|
| Rate for Payer: Three Rivers Provider Network All |
$9,438.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,074.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,146.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,704.05
|
| Rate for Payer: Zelis Auto |
$5,034.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,292.50
|
|
|
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 14MM
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$548.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Humana ChoiceCare |
$178.10
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$411.00
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$602.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$342.50
|
|
|
IMPLT CENTRALIZER DISTAL 14MM
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$479.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
|
|
IMPLT CENTRALIZER DISTAL 15MM
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$479.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
|
|
IMPLT CENTRALIZER DISTAL 15MM
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$548.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Humana ChoiceCare |
$178.10
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$411.00
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$602.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$342.50
|
|
|
IMPLT CENTRALIZER DISTAL 9MM
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$479.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
|
|
IMPLT CENTRALIZER DISTAL 9MM
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$548.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Humana ChoiceCare |
$178.10
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$411.00
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$602.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$342.50
|
|
|
IMPLT CENTRALIZER DISTAL SIZE 11MM
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$276.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$89.70
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$207.00
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$303.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$172.50
|
|
|
IMPLT CENTRALIZER DISTAL SIZE 11MM
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$276.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$241.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
|
|
IMPLT CENTRALIZER FEMORAL 11X35MM
|
Facility
|
IP
|
$9,369.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.60 |
| Max. Negotiated Rate |
$8,900.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,495.20
|
| Rate for Payer: Cash Price |
$5,621.40
|
| Rate for Payer: Cash Price |
$5,621.40
|
| Rate for Payer: Cigna Commercial |
$7,963.65
|
| Rate for Payer: First Health Commercial |
$8,432.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,432.10
|
| Rate for Payer: GEHA Commercial |
$6,558.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,432.10
|
| Rate for Payer: Multiplan All |
$8,525.79
|
| Rate for Payer: OMNI Networks Commercial |
$6,558.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8,432.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,900.55
|
| Rate for Payer: Three Rivers Provider Network All |
$7,026.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,713.17
|
| Rate for Payer: Zelis Auto |
$3,747.60
|
|
|
IMPLT CENTRALIZER FEMORAL 11X35MM
|
Facility
|
OP
|
$9,369.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.25 |
| Max. Negotiated Rate |
$8,900.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,621.40
|
| Rate for Payer: Cash Price |
$5,621.40
|
| Rate for Payer: Cash Price |
$5,621.40
|
| Rate for Payer: Cigna Commercial |
$7,963.65
|
| Rate for Payer: First Health Commercial |
$8,432.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,432.10
|
| Rate for Payer: GEHA Commercial |
$7,495.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,432.10
|
| Rate for Payer: Humana ChoiceCare |
$2,435.94
|
| Rate for Payer: Multiplan All |
$8,525.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,621.40
|
| Rate for Payer: OMNI Networks Commercial |
$6,558.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8,432.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,900.55
|
| Rate for Payer: Three Rivers Provider Network All |
$7,026.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,244.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,342.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,713.17
|
| Rate for Payer: Zelis Auto |
$3,747.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,684.50
|
|
|
IMPLT CENTRALIZER INTEGRAL 15X155MM
|
Facility
|
IP
|
$5,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.80 |
| Max. Negotiated Rate |
$5,597.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,713.60
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Cigna Commercial |
$5,008.20
|
| Rate for Payer: First Health Commercial |
$5,302.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,302.80
|
| Rate for Payer: GEHA Commercial |
$4,124.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,302.80
|
| Rate for Payer: Multiplan All |
$5,361.72
|
| Rate for Payer: OMNI Networks Commercial |
$4,124.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,302.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,597.40
|
| Rate for Payer: Three Rivers Provider Network All |
$4,419.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,479.56
|
| Rate for Payer: Zelis Auto |
$2,356.80
|
|
|
IMPLT CENTRALIZER INTEGRAL 15X155MM
|
Facility
|
OP
|
$5,892.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.00 |
| Max. Negotiated Rate |
$5,597.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,535.20
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Cigna Commercial |
$5,008.20
|
| Rate for Payer: First Health Commercial |
$5,302.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,302.80
|
| Rate for Payer: GEHA Commercial |
$4,713.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,302.80
|
| Rate for Payer: Humana ChoiceCare |
$1,531.92
|
| Rate for Payer: Multiplan All |
$5,361.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,535.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,124.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,302.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,597.40
|
| Rate for Payer: Three Rivers Provider Network All |
$4,419.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,184.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,473.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,479.56
|
| Rate for Payer: Zelis Auto |
$2,356.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,946.00
|
|
|
IMPLT CHIPS CANC 30CC 4-10MM
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$491.50 |
| Max. Negotiated Rate |
$1,867.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,179.60
|
| Rate for Payer: Cash Price |
$1,179.60
|
| Rate for Payer: Cash Price |
$1,179.60
|
| Rate for Payer: Cigna Commercial |
$1,671.10
|
| Rate for Payer: First Health Commercial |
$1,769.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,769.40
|
| Rate for Payer: GEHA Commercial |
$1,572.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,769.40
|
| Rate for Payer: Humana ChoiceCare |
$511.16
|
| Rate for Payer: Multiplan All |
$1,789.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,179.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,376.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,769.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,867.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,474.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,730.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$491.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,828.38
|
| Rate for Payer: Zelis Auto |
$786.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$983.00
|
|
|
IMPLT CHIPS CANC 30CC 4-10MM
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.40 |
| Max. Negotiated Rate |
$1,867.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,572.80
|
| Rate for Payer: Cash Price |
$1,179.60
|
| Rate for Payer: Cash Price |
$1,179.60
|
| Rate for Payer: Cigna Commercial |
$1,671.10
|
| Rate for Payer: First Health Commercial |
$1,769.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,769.40
|
| Rate for Payer: GEHA Commercial |
$1,376.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,769.40
|
| Rate for Payer: Multiplan All |
$1,789.06
|
| Rate for Payer: OMNI Networks Commercial |
$1,376.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,769.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,867.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,474.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,828.38
|
| Rate for Payer: Zelis Auto |
$786.40
|
|
|
IMPLT CHIPS CANC 5CC 1-8MM
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.50 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$843.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| Rate for Payer: Humana ChoiceCare |
$274.04
|
| Rate for Payer: Multiplan All |
$959.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$632.40
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,001.30
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$927.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$980.22
|
| Rate for Payer: Zelis Auto |
$421.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.00
|
|
|
IMPLT CHIPS CANC 5CC 1-8MM
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.60 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$843.20
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$737.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| Rate for Payer: Multiplan All |
$959.14
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,001.30
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$980.22
|
| Rate for Payer: Zelis Auto |
$421.60
|
|
|
IMPLT CHIPS CANC CRUTONS
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.25 |
| Max. Negotiated Rate |
$1,490.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$941.40
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cigna Commercial |
$1,333.65
|
| Rate for Payer: First Health Commercial |
$1,412.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,412.10
|
| Rate for Payer: GEHA Commercial |
$1,255.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,412.10
|
| Rate for Payer: Humana ChoiceCare |
$407.94
|
| Rate for Payer: Multiplan All |
$1,427.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$941.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,098.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,412.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,490.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,176.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,380.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$392.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,459.17
|
| Rate for Payer: Zelis Auto |
$627.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$784.50
|
|
|
IMPLT CHIPS CANC CRUTONS
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.60 |
| Max. Negotiated Rate |
$1,490.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,255.20
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cigna Commercial |
$1,333.65
|
| Rate for Payer: First Health Commercial |
$1,412.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,412.10
|
| Rate for Payer: GEHA Commercial |
$1,098.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,412.10
|
| Rate for Payer: Multiplan All |
$1,427.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,098.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,412.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,490.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,176.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,459.17
|
| Rate for Payer: Zelis Auto |
$627.60
|
|
|
IMPLT CLAMP PIN 5 HOLE
|
Facility
|
OP
|
$2,523.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.75 |
| Max. Negotiated Rate |
$2,396.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,513.80
|
| Rate for Payer: Cash Price |
$1,513.80
|
| Rate for Payer: Cash Price |
$1,513.80
|
| Rate for Payer: Cigna Commercial |
$2,144.55
|
| Rate for Payer: First Health Commercial |
$2,270.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,270.70
|
| Rate for Payer: GEHA Commercial |
$2,018.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,270.70
|
| Rate for Payer: Humana ChoiceCare |
$655.98
|
| Rate for Payer: Multiplan All |
$2,295.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,766.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,270.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,396.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,892.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,220.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$630.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,346.39
|
| Rate for Payer: Zelis Auto |
$1,009.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,261.50
|
|
|
IMPLT CLAMP PIN 5 HOLE
|
Facility
|
IP
|
$2,523.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.20 |
| Max. Negotiated Rate |
$2,396.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,018.40
|
| Rate for Payer: Cash Price |
$1,513.80
|
| Rate for Payer: Cash Price |
$1,513.80
|
| Rate for Payer: Cigna Commercial |
$2,144.55
|
| Rate for Payer: First Health Commercial |
$2,270.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,270.70
|
| Rate for Payer: GEHA Commercial |
$1,766.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,270.70
|
| Rate for Payer: Multiplan All |
$2,295.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,766.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,270.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,396.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,892.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,346.39
|
| Rate for Payer: Zelis Auto |
$1,009.20
|
|
|
IMPLT CLAMP PIN EX FIX HFMN 3 5 HL
|
Facility
|
IP
|
$3,093.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.51 |
| Max. Negotiated Rate |
$2,939.09 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,475.02
|
| Rate for Payer: Cash Price |
$1,856.27
|
| Rate for Payer: Cash Price |
$1,856.27
|
| Rate for Payer: Cigna Commercial |
$2,629.71
|
| Rate for Payer: First Health Commercial |
$2,784.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,784.40
|
| Rate for Payer: GEHA Commercial |
$2,165.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,784.40
|
| Rate for Payer: Multiplan All |
$2,815.34
|
| Rate for Payer: OMNI Networks Commercial |
$2,165.65
|
| Rate for Payer: One Health Plan PPO/POS |
$2,784.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,939.09
|
| Rate for Payer: Three Rivers Provider Network All |
$2,320.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,877.22
|
| Rate for Payer: Zelis Auto |
$1,237.51
|
|
|
IMPLT CLAMP PIN EX FIX HFMN 3 5 HL
|
Facility
|
OP
|
$3,093.78
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$773.45 |
| Max. Negotiated Rate |
$2,939.09 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,856.27
|
| Rate for Payer: Cash Price |
$1,856.27
|
| Rate for Payer: Cash Price |
$1,856.27
|
| Rate for Payer: Cigna Commercial |
$2,629.71
|
| Rate for Payer: First Health Commercial |
$2,784.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,784.40
|
| Rate for Payer: GEHA Commercial |
$2,475.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,784.40
|
| Rate for Payer: Humana ChoiceCare |
$804.38
|
| Rate for Payer: Multiplan All |
$2,815.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,856.27
|
| Rate for Payer: OMNI Networks Commercial |
$2,165.65
|
| Rate for Payer: One Health Plan PPO/POS |
$2,784.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,939.09
|
| Rate for Payer: Three Rivers Provider Network All |
$2,320.34
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,722.53
|
| Rate for Payer: United Healthcare Managed Medicaid |
$773.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,877.22
|
| Rate for Payer: Zelis Auto |
$1,237.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,546.89
|
|
|
IMPLT CLAMP PIN EX FIX HFMN 3 5 HL
|
Facility
|
IP
|
$3,063.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,225.20 |
| Max. Negotiated Rate |
$2,909.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,450.40
|
| Rate for Payer: Cash Price |
$1,837.80
|
| Rate for Payer: Cash Price |
$1,837.80
|
| Rate for Payer: Cigna Commercial |
$2,603.55
|
| Rate for Payer: First Health Commercial |
$2,756.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,756.70
|
| Rate for Payer: GEHA Commercial |
$2,144.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,756.70
|
| Rate for Payer: Multiplan All |
$2,787.33
|
| Rate for Payer: OMNI Networks Commercial |
$2,144.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,756.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,909.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,297.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,848.59
|
| Rate for Payer: Zelis Auto |
$1,225.20
|
|
