|
IMPLT CLAMP PIN EX FIX HFMN 3 5 HL
|
Facility
|
OP
|
$3,063.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$765.75 |
| Max. Negotiated Rate |
$2,909.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,837.80
|
| 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 |
$2,450.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,756.70
|
| Rate for Payer: Humana ChoiceCare |
$796.38
|
| Rate for Payer: Multiplan All |
$2,787.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,837.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$2,695.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$765.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,848.59
|
| Rate for Payer: Zelis Auto |
$1,225.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,531.50
|
|
|
IMPLT CLAMP PIN EX FIX PERIART MLPN
|
Facility
|
OP
|
$3,236.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.00 |
| Max. Negotiated Rate |
$3,074.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,941.60
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Cigna Commercial |
$2,750.60
|
| Rate for Payer: First Health Commercial |
$2,912.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,912.40
|
| Rate for Payer: GEHA Commercial |
$2,588.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,912.40
|
| Rate for Payer: Humana ChoiceCare |
$841.36
|
| Rate for Payer: Multiplan All |
$2,944.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,941.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,912.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,074.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,847.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$809.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,009.48
|
| Rate for Payer: Zelis Auto |
$1,294.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,618.00
|
|
|
IMPLT CLAMP PIN EX FIX PERIART MLPN
|
Facility
|
IP
|
$3,236.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.40 |
| Max. Negotiated Rate |
$3,074.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,588.80
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Cigna Commercial |
$2,750.60
|
| Rate for Payer: First Health Commercial |
$2,912.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,912.40
|
| Rate for Payer: GEHA Commercial |
$2,265.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,912.40
|
| Rate for Payer: Multiplan All |
$2,944.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,265.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,912.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,074.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,427.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,009.48
|
| Rate for Payer: Zelis Auto |
$1,294.40
|
|
|
IMPLT CLAMP PIN MUKI
|
Facility
|
IP
|
$1,879.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.60 |
| Max. Negotiated Rate |
$1,785.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,503.20
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$1,597.15
|
| Rate for Payer: First Health Commercial |
$1,691.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,691.10
|
| Rate for Payer: GEHA Commercial |
$1,315.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,691.10
|
| Rate for Payer: Multiplan All |
$1,709.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,315.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,691.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,785.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,409.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,747.47
|
| Rate for Payer: Zelis Auto |
$751.60
|
|
|
IMPLT CLAMP PIN MUKI
|
Facility
|
OP
|
$1,879.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.75 |
| Max. Negotiated Rate |
$1,785.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,127.40
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$1,597.15
|
| Rate for Payer: First Health Commercial |
$1,691.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,691.10
|
| Rate for Payer: GEHA Commercial |
$1,503.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,691.10
|
| Rate for Payer: Humana ChoiceCare |
$488.54
|
| Rate for Payer: Multiplan All |
$1,709.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,127.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,315.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,691.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,785.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,409.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,653.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$469.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,747.47
|
| Rate for Payer: Zelis Auto |
$751.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$939.50
|
|
|
IMPLT CLAW II 2-HOLE 20MM
|
Facility
|
IP
|
$4,778.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,911.20 |
| Max. Negotiated Rate |
$4,539.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,822.40
|
| Rate for Payer: Cash Price |
$2,866.80
|
| Rate for Payer: Cash Price |
$2,866.80
|
| Rate for Payer: Cigna Commercial |
$4,061.30
|
| Rate for Payer: First Health Commercial |
$4,300.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,300.20
|
| Rate for Payer: GEHA Commercial |
$3,344.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,300.20
|
| Rate for Payer: Multiplan All |
$4,347.98
|
| Rate for Payer: OMNI Networks Commercial |
$3,344.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,300.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,539.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,583.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,443.54
|
| Rate for Payer: Zelis Auto |
$1,911.20
|
|
|
IMPLT CLAW II 2-HOLE 20MM
|
Facility
|
OP
|
$4,778.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$4,539.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,866.80
|
| Rate for Payer: Cash Price |
$2,866.80
|
| Rate for Payer: Cash Price |
$2,866.80
|
| Rate for Payer: Cigna Commercial |
$4,061.30
|
| Rate for Payer: First Health Commercial |
$4,300.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,300.20
|
| Rate for Payer: GEHA Commercial |
$3,822.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,300.20
|
| Rate for Payer: Humana ChoiceCare |
$1,242.28
|
| Rate for Payer: Multiplan All |
$4,347.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,866.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,344.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,300.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,539.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,583.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,204.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,194.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,443.54
|
| Rate for Payer: Zelis Auto |
$1,911.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,389.00
|
|
|
IMPLT CLAW II 2-HOLE 25MM
|
Facility
|
IP
|
$4,778.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,911.20 |
| Max. Negotiated Rate |
$4,539.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,822.40
|
| Rate for Payer: Cash Price |
$2,866.80
|
| Rate for Payer: Cash Price |
$2,866.80
|
| Rate for Payer: Cigna Commercial |
$4,061.30
|
| Rate for Payer: First Health Commercial |
$4,300.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,300.20
|
| Rate for Payer: GEHA Commercial |
$3,344.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,300.20
|
| Rate for Payer: Multiplan All |
$4,347.98
|
| Rate for Payer: OMNI Networks Commercial |
$3,344.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,300.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,539.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,583.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,443.54
|
| Rate for Payer: Zelis Auto |
$1,911.20
|
|
|
IMPLT CLAW II 2-HOLE 25MM
|
Facility
|
OP
|
$4,778.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$4,539.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,866.80
|
| Rate for Payer: Cash Price |
$2,866.80
|
| Rate for Payer: Cash Price |
$2,866.80
|
| Rate for Payer: Cigna Commercial |
$4,061.30
|
| Rate for Payer: First Health Commercial |
$4,300.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,300.20
|
| Rate for Payer: GEHA Commercial |
$3,822.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,300.20
|
| Rate for Payer: Humana ChoiceCare |
$1,242.28
|
| Rate for Payer: Multiplan All |
$4,347.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,866.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,344.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,300.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,539.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,583.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,204.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,194.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,443.54
|
| Rate for Payer: Zelis Auto |
$1,911.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,389.00
|
|
|
IMPLT CLAW II 2-HOLE 30MM
|
Facility
|
OP
|
$4,778.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$4,539.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,866.80
|
| Rate for Payer: Cash Price |
$2,866.80
|
| Rate for Payer: Cash Price |
$2,866.80
|
| Rate for Payer: Cigna Commercial |
$4,061.30
|
| Rate for Payer: First Health Commercial |
$4,300.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,300.20
|
| Rate for Payer: GEHA Commercial |
$3,822.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,300.20
|
| Rate for Payer: Humana ChoiceCare |
$1,242.28
|
| Rate for Payer: Multiplan All |
$4,347.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,866.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,344.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,300.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,539.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,583.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,204.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,194.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,443.54
|
| Rate for Payer: Zelis Auto |
$1,911.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,389.00
|
|
|
IMPLT CLAW II 2-HOLE 30MM
|
Facility
|
IP
|
$4,778.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,911.20 |
| Max. Negotiated Rate |
$4,539.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,822.40
|
| Rate for Payer: Cash Price |
$2,866.80
|
| Rate for Payer: Cash Price |
$2,866.80
|
| Rate for Payer: Cigna Commercial |
$4,061.30
|
| Rate for Payer: First Health Commercial |
$4,300.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,300.20
|
| Rate for Payer: GEHA Commercial |
$3,344.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,300.20
|
| Rate for Payer: Multiplan All |
$4,347.98
|
| Rate for Payer: OMNI Networks Commercial |
$3,344.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,300.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,539.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,583.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,443.54
|
| Rate for Payer: Zelis Auto |
$1,911.20
|
|
|
IMPLT CLAW II 4-HOLE 20MM
|
Facility
|
IP
|
$5,661.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,264.40 |
| Max. Negotiated Rate |
$5,377.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,528.80
|
| Rate for Payer: Cash Price |
$3,396.60
|
| Rate for Payer: Cash Price |
$3,396.60
|
| Rate for Payer: Cigna Commercial |
$4,811.85
|
| Rate for Payer: First Health Commercial |
$5,094.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,094.90
|
| Rate for Payer: GEHA Commercial |
$3,962.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,094.90
|
| Rate for Payer: Multiplan All |
$5,151.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,962.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,094.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,377.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,245.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,264.73
|
| Rate for Payer: Zelis Auto |
$2,264.40
|
|
|
IMPLT CLAW II 4-HOLE 20MM
|
Facility
|
OP
|
$5,661.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.25 |
| Max. Negotiated Rate |
$5,377.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,396.60
|
| Rate for Payer: Cash Price |
$3,396.60
|
| Rate for Payer: Cash Price |
$3,396.60
|
| Rate for Payer: Cigna Commercial |
$4,811.85
|
| Rate for Payer: First Health Commercial |
$5,094.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,094.90
|
| Rate for Payer: GEHA Commercial |
$4,528.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,094.90
|
| Rate for Payer: Humana ChoiceCare |
$1,471.86
|
| Rate for Payer: Multiplan All |
$5,151.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,396.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,962.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,094.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,377.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,245.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,981.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,415.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,264.73
|
| Rate for Payer: Zelis Auto |
$2,264.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,830.50
|
|
|
IMPLT CLAW II 4-HOLE 25MM
|
Facility
|
IP
|
$5,661.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,264.40 |
| Max. Negotiated Rate |
$5,377.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,528.80
|
| Rate for Payer: Cash Price |
$3,396.60
|
| Rate for Payer: Cash Price |
$3,396.60
|
| Rate for Payer: Cigna Commercial |
$4,811.85
|
| Rate for Payer: First Health Commercial |
$5,094.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,094.90
|
| Rate for Payer: GEHA Commercial |
$3,962.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,094.90
|
| Rate for Payer: Multiplan All |
$5,151.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,962.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,094.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,377.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,245.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,264.73
|
| Rate for Payer: Zelis Auto |
$2,264.40
|
|
|
IMPLT CLAW II 4-HOLE 25MM
|
Facility
|
OP
|
$5,661.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.25 |
| Max. Negotiated Rate |
$5,377.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,396.60
|
| Rate for Payer: Cash Price |
$3,396.60
|
| Rate for Payer: Cash Price |
$3,396.60
|
| Rate for Payer: Cigna Commercial |
$4,811.85
|
| Rate for Payer: First Health Commercial |
$5,094.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,094.90
|
| Rate for Payer: GEHA Commercial |
$4,528.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,094.90
|
| Rate for Payer: Humana ChoiceCare |
$1,471.86
|
| Rate for Payer: Multiplan All |
$5,151.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,396.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,962.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,094.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,377.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,245.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,981.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,415.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,264.73
|
| Rate for Payer: Zelis Auto |
$2,264.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,830.50
|
|
|
IMPLT CLIP EASY 17MM
|
Facility
|
IP
|
$5,029.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.60 |
| Max. Negotiated Rate |
$4,777.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,023.20
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cigna Commercial |
$4,274.65
|
| Rate for Payer: First Health Commercial |
$4,526.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,526.10
|
| Rate for Payer: GEHA Commercial |
$3,520.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,526.10
|
| Rate for Payer: Multiplan All |
$4,576.39
|
| Rate for Payer: OMNI Networks Commercial |
$3,520.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,526.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,777.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,771.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,676.97
|
| Rate for Payer: Zelis Auto |
$2,011.60
|
|
|
IMPLT CLIP EASY 17MM
|
Facility
|
OP
|
$5,029.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.25 |
| Max. Negotiated Rate |
$4,777.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,017.40
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cigna Commercial |
$4,274.65
|
| Rate for Payer: First Health Commercial |
$4,526.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,526.10
|
| Rate for Payer: GEHA Commercial |
$4,023.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,526.10
|
| Rate for Payer: Humana ChoiceCare |
$1,307.54
|
| Rate for Payer: Multiplan All |
$4,576.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,017.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,520.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,526.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,777.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,771.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,425.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,676.97
|
| Rate for Payer: Zelis Auto |
$2,011.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,514.50
|
|
|
IMPLT CLIP EASY 20MM
|
Facility
|
OP
|
$6,257.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.25 |
| Max. Negotiated Rate |
$5,944.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,754.20
|
| Rate for Payer: Cash Price |
$3,754.20
|
| Rate for Payer: Cash Price |
$3,754.20
|
| Rate for Payer: Cigna Commercial |
$5,318.45
|
| Rate for Payer: First Health Commercial |
$5,631.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,631.30
|
| Rate for Payer: GEHA Commercial |
$5,005.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,631.30
|
| Rate for Payer: Humana ChoiceCare |
$1,626.82
|
| Rate for Payer: Multiplan All |
$5,693.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,754.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,379.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,631.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,944.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,692.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,506.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,564.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,819.01
|
| Rate for Payer: Zelis Auto |
$2,502.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,128.50
|
|
|
IMPLT CLIP EASY 20MM
|
Facility
|
IP
|
$6,257.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,502.80 |
| Max. Negotiated Rate |
$5,944.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,005.60
|
| Rate for Payer: Cash Price |
$3,754.20
|
| Rate for Payer: Cash Price |
$3,754.20
|
| Rate for Payer: Cigna Commercial |
$5,318.45
|
| Rate for Payer: First Health Commercial |
$5,631.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,631.30
|
| Rate for Payer: GEHA Commercial |
$4,379.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,631.30
|
| Rate for Payer: Multiplan All |
$5,693.87
|
| Rate for Payer: OMNI Networks Commercial |
$4,379.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,631.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,944.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,692.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,819.01
|
| Rate for Payer: Zelis Auto |
$2,502.80
|
|
|
IMPLT CLIP,EASY 20MM
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90006614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.50 |
| Max. Negotiated Rate |
$982.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$620.40
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cigna Commercial |
$878.90
|
| Rate for Payer: First Health Commercial |
$930.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$930.60
|
| Rate for Payer: GEHA Commercial |
$827.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$930.60
|
| Rate for Payer: Humana ChoiceCare |
$268.84
|
| Rate for Payer: Multiplan All |
$940.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$620.40
|
| Rate for Payer: OMNI Networks Commercial |
$723.80
|
| Rate for Payer: One Health Plan PPO/POS |
$930.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$982.30
|
| Rate for Payer: Three Rivers Provider Network All |
$775.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$909.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$258.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$961.62
|
| Rate for Payer: Zelis Auto |
$413.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$517.00
|
|
|
IMPLT CLIP,EASY 20MM
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90006614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.60 |
| Max. Negotiated Rate |
$982.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$827.20
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cigna Commercial |
$878.90
|
| Rate for Payer: First Health Commercial |
$930.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$930.60
|
| Rate for Payer: GEHA Commercial |
$723.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$930.60
|
| Rate for Payer: Multiplan All |
$940.94
|
| Rate for Payer: OMNI Networks Commercial |
$723.80
|
| Rate for Payer: One Health Plan PPO/POS |
$930.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$982.30
|
| Rate for Payer: Three Rivers Provider Network All |
$775.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$961.62
|
| Rate for Payer: Zelis Auto |
$413.60
|
|
|
IMPLT CLIP,EASY EZ15-15-15
|
Facility
|
OP
|
$5,029.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.25 |
| Max. Negotiated Rate |
$4,777.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,017.40
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cigna Commercial |
$4,274.65
|
| Rate for Payer: First Health Commercial |
$4,526.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,526.10
|
| Rate for Payer: GEHA Commercial |
$4,023.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,526.10
|
| Rate for Payer: Humana ChoiceCare |
$1,307.54
|
| Rate for Payer: Multiplan All |
$4,576.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,017.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,520.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,526.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,777.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,771.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,425.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,676.97
|
| Rate for Payer: Zelis Auto |
$2,011.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,514.50
|
|
|
IMPLT CLIP,EASY EZ15-15-15
|
Facility
|
IP
|
$5,029.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.60 |
| Max. Negotiated Rate |
$4,777.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,023.20
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cigna Commercial |
$4,274.65
|
| Rate for Payer: First Health Commercial |
$4,526.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,526.10
|
| Rate for Payer: GEHA Commercial |
$3,520.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,526.10
|
| Rate for Payer: Multiplan All |
$4,576.39
|
| Rate for Payer: OMNI Networks Commercial |
$3,520.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,526.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,777.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,771.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,676.97
|
| Rate for Payer: Zelis Auto |
$2,011.60
|
|
|
IMPLT CLIP EASY EZ18-14-14
|
Facility
|
OP
|
$5,029.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.25 |
| Max. Negotiated Rate |
$4,777.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,017.40
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cigna Commercial |
$4,274.65
|
| Rate for Payer: First Health Commercial |
$4,526.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,526.10
|
| Rate for Payer: GEHA Commercial |
$4,023.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,526.10
|
| Rate for Payer: Humana ChoiceCare |
$1,307.54
|
| Rate for Payer: Multiplan All |
$4,576.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,017.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,520.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,526.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,777.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,771.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,425.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,676.97
|
| Rate for Payer: Zelis Auto |
$2,011.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,514.50
|
|
|
IMPLT CLIP EASY EZ18-14-14
|
Facility
|
IP
|
$5,029.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.60 |
| Max. Negotiated Rate |
$4,777.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,023.20
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cash Price |
$3,017.40
|
| Rate for Payer: Cigna Commercial |
$4,274.65
|
| Rate for Payer: First Health Commercial |
$4,526.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,526.10
|
| Rate for Payer: GEHA Commercial |
$3,520.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,526.10
|
| Rate for Payer: Multiplan All |
$4,576.39
|
| Rate for Payer: OMNI Networks Commercial |
$3,520.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,526.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,777.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,771.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,676.97
|
| Rate for Payer: Zelis Auto |
$2,011.60
|
|
