|
IMPLT CLIP EASY EZ20-16-16
|
Facility
|
OP
|
$5,696.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.00 |
| Max. Negotiated Rate |
$5,411.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,417.60
|
| Rate for Payer: Cash Price |
$3,417.60
|
| Rate for Payer: Cash Price |
$3,417.60
|
| Rate for Payer: Cigna Commercial |
$4,841.60
|
| Rate for Payer: First Health Commercial |
$5,126.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,126.40
|
| Rate for Payer: GEHA Commercial |
$4,556.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,126.40
|
| Rate for Payer: Humana ChoiceCare |
$1,480.96
|
| Rate for Payer: Multiplan All |
$5,183.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,417.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,987.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,126.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,411.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,272.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,012.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,424.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,297.28
|
| Rate for Payer: Zelis Auto |
$2,278.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,848.00
|
|
|
IMPLT CLIP EASY EZ20-16-16
|
Facility
|
IP
|
$5,696.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,278.40 |
| Max. Negotiated Rate |
$5,411.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,556.80
|
| Rate for Payer: Cash Price |
$3,417.60
|
| Rate for Payer: Cash Price |
$3,417.60
|
| Rate for Payer: Cigna Commercial |
$4,841.60
|
| Rate for Payer: First Health Commercial |
$5,126.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,126.40
|
| Rate for Payer: GEHA Commercial |
$3,987.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,126.40
|
| Rate for Payer: Multiplan All |
$5,183.36
|
| Rate for Payer: OMNI Networks Commercial |
$3,987.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,126.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,411.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,272.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,297.28
|
| Rate for Payer: Zelis Auto |
$2,278.40
|
|
|
IMPLT CLIP EASY EZ25-22-22
|
Facility
|
IP
|
$6,150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.00 |
| Max. Negotiated Rate |
$5,842.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,920.00
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$5,227.50
|
| Rate for Payer: First Health Commercial |
$5,535.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,535.00
|
| Rate for Payer: GEHA Commercial |
$4,305.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,535.00
|
| Rate for Payer: Multiplan All |
$5,596.50
|
| Rate for Payer: OMNI Networks Commercial |
$4,305.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,535.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,842.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,612.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,719.50
|
| Rate for Payer: Zelis Auto |
$2,460.00
|
|
|
IMPLT CLIP EASY EZ25-22-22
|
Facility
|
OP
|
$6,150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.50 |
| Max. Negotiated Rate |
$5,842.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,690.00
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$5,227.50
|
| Rate for Payer: First Health Commercial |
$5,535.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,535.00
|
| Rate for Payer: GEHA Commercial |
$4,920.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,535.00
|
| Rate for Payer: Humana ChoiceCare |
$1,599.00
|
| Rate for Payer: Multiplan All |
$5,596.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,690.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,305.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,535.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,842.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,612.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,412.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,537.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,719.50
|
| Rate for Payer: Zelis Auto |
$2,460.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,075.00
|
|
|
IMPLT CLIP EASY STRYKER
|
Facility
|
OP
|
$10,618.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,654.50 |
| Max. Negotiated Rate |
$10,087.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,370.80
|
| Rate for Payer: Cash Price |
$6,370.80
|
| Rate for Payer: Cash Price |
$6,370.80
|
| Rate for Payer: Cigna Commercial |
$9,025.30
|
| Rate for Payer: First Health Commercial |
$9,556.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,556.20
|
| Rate for Payer: GEHA Commercial |
$8,494.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,556.20
|
| Rate for Payer: Humana ChoiceCare |
$2,760.68
|
| Rate for Payer: Multiplan All |
$9,662.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,370.80
|
| Rate for Payer: OMNI Networks Commercial |
$7,432.60
|
| Rate for Payer: One Health Plan PPO/POS |
$9,556.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,087.10
|
| Rate for Payer: Three Rivers Provider Network All |
$7,963.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,343.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,654.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,874.74
|
| Rate for Payer: Zelis Auto |
$4,247.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,309.00
|
|
|
IMPLT CLIP EASY STRYKER
|
Facility
|
IP
|
$10,618.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,247.20 |
| Max. Negotiated Rate |
$10,087.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,494.40
|
| Rate for Payer: Cash Price |
$6,370.80
|
| Rate for Payer: Cash Price |
$6,370.80
|
| Rate for Payer: Cigna Commercial |
$9,025.30
|
| Rate for Payer: First Health Commercial |
$9,556.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,556.20
|
| Rate for Payer: GEHA Commercial |
$7,432.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,556.20
|
| Rate for Payer: Multiplan All |
$9,662.38
|
| Rate for Payer: OMNI Networks Commercial |
$7,432.60
|
| Rate for Payer: One Health Plan PPO/POS |
$9,556.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,087.10
|
| Rate for Payer: Three Rivers Provider Network All |
$7,963.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,874.74
|
| Rate for Payer: Zelis Auto |
$4,247.20
|
|
|
IMPLT CLIP LIGATING MEDIUM
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$20.40
|
| Rate for Payer: First Health Commercial |
$21.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$21.60
|
| Rate for Payer: GEHA Commercial |
$19.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$21.60
|
| Rate for Payer: Humana ChoiceCare |
$6.24
|
| Rate for Payer: Multiplan All |
$21.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.40
|
| Rate for Payer: OMNI Networks Commercial |
$16.80
|
| Rate for Payer: One Health Plan PPO/POS |
$21.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$22.80
|
| Rate for Payer: Three Rivers Provider Network All |
$18.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$21.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$22.32
|
| Rate for Payer: Zelis Auto |
$9.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.00
|
|
|
IMPLT CLIP LIGATING MEDIUM
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.20
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$20.40
|
| Rate for Payer: First Health Commercial |
$21.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$21.60
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$21.60
|
| Rate for Payer: Multiplan All |
$21.84
|
| Rate for Payer: OMNI Networks Commercial |
$16.80
|
| Rate for Payer: One Health Plan PPO/POS |
$21.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$22.80
|
| Rate for Payer: Three Rivers Provider Network All |
$18.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$22.32
|
| Rate for Payer: Zelis Auto |
$9.60
|
|
|
IMPLT CLIP RESOLUTION 360
|
Facility
|
OP
|
$1,626.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.50 |
| Max. Negotiated Rate |
$1,544.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$975.60
|
| Rate for Payer: Cash Price |
$975.60
|
| Rate for Payer: Cash Price |
$975.60
|
| Rate for Payer: Cigna Commercial |
$1,382.10
|
| Rate for Payer: First Health Commercial |
$1,463.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,463.40
|
| Rate for Payer: GEHA Commercial |
$1,300.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,463.40
|
| Rate for Payer: Humana ChoiceCare |
$422.76
|
| Rate for Payer: Multiplan All |
$1,479.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$975.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,138.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,463.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,544.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,219.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,430.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$406.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,512.18
|
| Rate for Payer: Zelis Auto |
$650.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$813.00
|
|
|
IMPLT CLIP RESOLUTION 360
|
Facility
|
IP
|
$1,626.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.40 |
| Max. Negotiated Rate |
$1,544.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,300.80
|
| Rate for Payer: Cash Price |
$975.60
|
| Rate for Payer: Cash Price |
$975.60
|
| Rate for Payer: Cigna Commercial |
$1,382.10
|
| Rate for Payer: First Health Commercial |
$1,463.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,463.40
|
| Rate for Payer: GEHA Commercial |
$1,138.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,463.40
|
| Rate for Payer: Multiplan All |
$1,479.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,138.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,463.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,544.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,512.18
|
| Rate for Payer: Zelis Auto |
$650.40
|
|
|
IMPLT COLLAGEN MATRIX NEUROFLEX
|
Facility
|
OP
|
$4,803.00
|
|
|
Service Code
|
CPT C9355
|
| Hospital Charge Code |
7002455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.75 |
| Max. Negotiated Rate |
$4,562.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,881.80
|
| Rate for Payer: Cash Price |
$2,881.80
|
| Rate for Payer: Cash Price |
$2,881.80
|
| Rate for Payer: Cigna Commercial |
$4,082.55
|
| Rate for Payer: First Health Commercial |
$4,322.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,322.70
|
| Rate for Payer: GEHA Commercial |
$3,842.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,322.70
|
| Rate for Payer: Humana ChoiceCare |
$1,248.78
|
| Rate for Payer: Multiplan All |
$4,370.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,881.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,362.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,322.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,562.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,602.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,226.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,200.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,466.79
|
| Rate for Payer: Zelis Auto |
$1,921.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,401.50
|
|
|
IMPLT COLLAGEN MATRIX NEUROFLEX
|
Facility
|
OP
|
$4,803.00
|
|
|
Service Code
|
CPT C9355
|
| Hospital Charge Code |
7002456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.75 |
| Max. Negotiated Rate |
$4,562.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,881.80
|
| Rate for Payer: Cash Price |
$2,881.80
|
| Rate for Payer: Cash Price |
$2,881.80
|
| Rate for Payer: Cigna Commercial |
$4,082.55
|
| Rate for Payer: First Health Commercial |
$4,322.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,322.70
|
| Rate for Payer: GEHA Commercial |
$3,842.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,322.70
|
| Rate for Payer: Humana ChoiceCare |
$1,248.78
|
| Rate for Payer: Multiplan All |
$4,370.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,881.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,362.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,322.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,562.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,602.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,226.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,200.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,466.79
|
| Rate for Payer: Zelis Auto |
$1,921.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,401.50
|
|
|
IMPLT COLLAGEN MATRIX NEUROFLEX
|
Facility
|
IP
|
$4,803.00
|
|
|
Service Code
|
CPT C9355
|
| Hospital Charge Code |
7002456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,921.20 |
| Max. Negotiated Rate |
$4,562.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,842.40
|
| Rate for Payer: Cash Price |
$2,881.80
|
| Rate for Payer: Cash Price |
$2,881.80
|
| Rate for Payer: Cigna Commercial |
$4,082.55
|
| Rate for Payer: First Health Commercial |
$4,322.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,322.70
|
| Rate for Payer: GEHA Commercial |
$3,362.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,322.70
|
| Rate for Payer: Multiplan All |
$4,370.73
|
| Rate for Payer: OMNI Networks Commercial |
$3,362.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,322.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,562.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,602.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,466.79
|
| Rate for Payer: Zelis Auto |
$1,921.20
|
|
|
IMPLT COLLAGEN MATRIX NEUROFLEX
|
Facility
|
IP
|
$4,803.00
|
|
|
Service Code
|
CPT C9355
|
| Hospital Charge Code |
7002455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,921.20 |
| Max. Negotiated Rate |
$4,562.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,842.40
|
| Rate for Payer: Cash Price |
$2,881.80
|
| Rate for Payer: Cash Price |
$2,881.80
|
| Rate for Payer: Cigna Commercial |
$4,082.55
|
| Rate for Payer: First Health Commercial |
$4,322.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,322.70
|
| Rate for Payer: GEHA Commercial |
$3,362.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,322.70
|
| Rate for Payer: Multiplan All |
$4,370.73
|
| Rate for Payer: OMNI Networks Commercial |
$3,362.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,322.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,562.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,602.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,466.79
|
| Rate for Payer: Zelis Auto |
$1,921.20
|
|
|
IMPLT COMP FEMORAL STABILIZER LFT #7
|
Facility
|
IP
|
$18,037.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,214.80 |
| Max. Negotiated Rate |
$17,135.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$14,429.60
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cigna Commercial |
$15,331.45
|
| Rate for Payer: First Health Commercial |
$16,233.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,233.30
|
| Rate for Payer: GEHA Commercial |
$12,625.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,233.30
|
| Rate for Payer: Multiplan All |
$16,413.67
|
| Rate for Payer: OMNI Networks Commercial |
$12,625.90
|
| Rate for Payer: One Health Plan PPO/POS |
$16,233.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,135.15
|
| Rate for Payer: Three Rivers Provider Network All |
$13,527.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,774.41
|
| Rate for Payer: Zelis Auto |
$7,214.80
|
|
|
IMPLT COMP FEMORAL STABILIZER LFT #7
|
Facility
|
OP
|
$18,037.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,509.25 |
| Max. Negotiated Rate |
$17,135.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,822.20
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cash Price |
$10,822.20
|
| Rate for Payer: Cigna Commercial |
$15,331.45
|
| Rate for Payer: First Health Commercial |
$16,233.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$16,233.30
|
| Rate for Payer: GEHA Commercial |
$14,429.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$16,233.30
|
| Rate for Payer: Humana ChoiceCare |
$4,689.62
|
| Rate for Payer: Multiplan All |
$16,413.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,822.20
|
| Rate for Payer: OMNI Networks Commercial |
$12,625.90
|
| Rate for Payer: One Health Plan PPO/POS |
$16,233.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$17,135.15
|
| Rate for Payer: Three Rivers Provider Network All |
$13,527.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15,872.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,509.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,774.41
|
| Rate for Payer: Zelis Auto |
$7,214.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,018.50
|
|
|
IMPLT COMPONENT BIPOLAR HEAD OD41MM
|
Facility
|
OP
|
$2,817.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$704.25 |
| Max. Negotiated Rate |
$2,676.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,690.20
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cigna Commercial |
$2,394.45
|
| Rate for Payer: First Health Commercial |
$2,535.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,535.30
|
| Rate for Payer: GEHA Commercial |
$2,253.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,535.30
|
| Rate for Payer: Humana ChoiceCare |
$732.42
|
| Rate for Payer: Multiplan All |
$2,563.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,690.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,971.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,535.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,676.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,112.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,478.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$704.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,619.81
|
| Rate for Payer: Zelis Auto |
$1,126.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,408.50
|
|
|
IMPLT COMPONENT BIPOLAR HEAD OD41MM
|
Facility
|
IP
|
$2,817.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.80 |
| Max. Negotiated Rate |
$2,676.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,253.60
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cigna Commercial |
$2,394.45
|
| Rate for Payer: First Health Commercial |
$2,535.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,535.30
|
| Rate for Payer: GEHA Commercial |
$1,971.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,535.30
|
| Rate for Payer: Multiplan All |
$2,563.47
|
| Rate for Payer: OMNI Networks Commercial |
$1,971.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,535.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,676.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,112.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,619.81
|
| Rate for Payer: Zelis Auto |
$1,126.80
|
|
|
IMPLT COMPONENT BIPOLAR HEAD OD 42MM
|
Facility
|
IP
|
$2,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.00 |
| Max. Negotiated Rate |
$2,113.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,780.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$1,891.25
|
| Rate for Payer: First Health Commercial |
$2,002.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,002.50
|
| Rate for Payer: GEHA Commercial |
$1,557.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,002.50
|
| Rate for Payer: Multiplan All |
$2,024.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,557.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,002.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,113.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,069.25
|
| Rate for Payer: Zelis Auto |
$890.00
|
|
|
IMPLT COMPONENT BIPOLAR HEAD OD 42MM
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.25 |
| Max. Negotiated Rate |
$2,113.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$1,891.25
|
| Rate for Payer: First Health Commercial |
$2,002.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,002.50
|
| Rate for Payer: GEHA Commercial |
$1,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,002.50
|
| Rate for Payer: Humana ChoiceCare |
$578.50
|
| Rate for Payer: Multiplan All |
$2,024.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,335.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,557.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,002.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,113.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,958.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$556.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,069.25
|
| Rate for Payer: Zelis Auto |
$890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,112.50
|
|
|
IMPLT COMPONENT BIPOLAR HEAD OD51MM
|
Facility
|
IP
|
$2,817.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.80 |
| Max. Negotiated Rate |
$2,676.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,253.60
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cigna Commercial |
$2,394.45
|
| Rate for Payer: First Health Commercial |
$2,535.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,535.30
|
| Rate for Payer: GEHA Commercial |
$1,971.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,535.30
|
| Rate for Payer: Multiplan All |
$2,563.47
|
| Rate for Payer: OMNI Networks Commercial |
$1,971.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,535.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,676.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,112.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,619.81
|
| Rate for Payer: Zelis Auto |
$1,126.80
|
|
|
IMPLT COMPONENT BIPOLAR HEAD OD51MM
|
Facility
|
OP
|
$2,817.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$704.25 |
| Max. Negotiated Rate |
$2,676.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,690.20
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cigna Commercial |
$2,394.45
|
| Rate for Payer: First Health Commercial |
$2,535.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,535.30
|
| Rate for Payer: GEHA Commercial |
$2,253.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,535.30
|
| Rate for Payer: Humana ChoiceCare |
$732.42
|
| Rate for Payer: Multiplan All |
$2,563.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,690.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,971.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,535.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,676.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,112.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,478.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$704.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,619.81
|
| Rate for Payer: Zelis Auto |
$1,126.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,408.50
|
|
|
IMPLT COMPONENT BIPOLAR HEAD UNIVERSAL
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.25 |
| Max. Negotiated Rate |
$2,113.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$1,891.25
|
| Rate for Payer: First Health Commercial |
$2,002.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,002.50
|
| Rate for Payer: GEHA Commercial |
$1,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,002.50
|
| Rate for Payer: Humana ChoiceCare |
$578.50
|
| Rate for Payer: Multiplan All |
$2,024.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,335.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,557.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,002.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,113.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,958.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$556.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,069.25
|
| Rate for Payer: Zelis Auto |
$890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,112.50
|
|
|
IMPLT COMPONENT BIPOLAR HEAD UNIVERSAL
|
Facility
|
IP
|
$2,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.00 |
| Max. Negotiated Rate |
$2,113.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,780.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$1,891.25
|
| Rate for Payer: First Health Commercial |
$2,002.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,002.50
|
| Rate for Payer: GEHA Commercial |
$1,557.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,002.50
|
| Rate for Payer: Multiplan All |
$2,024.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,557.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,002.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,113.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,069.25
|
| Rate for Payer: Zelis Auto |
$890.00
|
|
|
IMPLT COMPONENT BIPOLAR HEAD UNIVERSAL
|
Facility
|
OP
|
$2,817.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$704.25 |
| Max. Negotiated Rate |
$2,676.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,690.20
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cash Price |
$1,690.20
|
| Rate for Payer: Cigna Commercial |
$2,394.45
|
| Rate for Payer: First Health Commercial |
$2,535.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,535.30
|
| Rate for Payer: GEHA Commercial |
$2,253.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,535.30
|
| Rate for Payer: Humana ChoiceCare |
$732.42
|
| Rate for Payer: Multiplan All |
$2,563.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,690.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,971.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,535.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,676.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,112.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,478.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$704.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,619.81
|
| Rate for Payer: Zelis Auto |
$1,126.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,408.50
|
|
