|
IMPLT COMPONENT TIBIAL SIZE 7
|
Facility
|
IP
|
$6,437.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.80 |
| Max. Negotiated Rate |
$6,115.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,149.60
|
| Rate for Payer: Cash Price |
$3,862.20
|
| Rate for Payer: Cash Price |
$3,862.20
|
| Rate for Payer: Cigna Commercial |
$5,471.45
|
| Rate for Payer: First Health Commercial |
$5,793.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,793.30
|
| Rate for Payer: GEHA Commercial |
$4,505.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,793.30
|
| Rate for Payer: Multiplan All |
$5,857.67
|
| Rate for Payer: OMNI Networks Commercial |
$4,505.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,793.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,115.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,827.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,986.41
|
| Rate for Payer: Zelis Auto |
$2,574.80
|
|
|
IMPLT COMPONENT TIBIAL SIZE 7
|
Facility
|
OP
|
$6,437.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,609.25 |
| Max. Negotiated Rate |
$6,115.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,862.20
|
| Rate for Payer: Cash Price |
$3,862.20
|
| Rate for Payer: Cash Price |
$3,862.20
|
| Rate for Payer: Cigna Commercial |
$5,471.45
|
| Rate for Payer: First Health Commercial |
$5,793.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,793.30
|
| Rate for Payer: GEHA Commercial |
$5,149.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,793.30
|
| Rate for Payer: Humana ChoiceCare |
$1,673.62
|
| Rate for Payer: Multiplan All |
$5,857.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,862.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,505.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,793.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,115.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,827.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,664.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,609.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,986.41
|
| Rate for Payer: Zelis Auto |
$2,574.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,218.50
|
|
|
IMPLT COMPONENT TIBIAL SZ 2
|
Facility
|
OP
|
$5,329.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,332.25 |
| Max. Negotiated Rate |
$5,062.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,197.40
|
| Rate for Payer: Cash Price |
$3,197.40
|
| Rate for Payer: Cash Price |
$3,197.40
|
| Rate for Payer: Cigna Commercial |
$4,529.65
|
| Rate for Payer: First Health Commercial |
$4,796.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,796.10
|
| Rate for Payer: GEHA Commercial |
$4,263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,796.10
|
| Rate for Payer: Humana ChoiceCare |
$1,385.54
|
| Rate for Payer: Multiplan All |
$4,849.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,197.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,730.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,796.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,062.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,996.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,689.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,332.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,955.97
|
| Rate for Payer: Zelis Auto |
$2,131.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,664.50
|
|
|
IMPLT COMPONENT TIBIAL SZ 2
|
Facility
|
IP
|
$5,329.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.60 |
| Max. Negotiated Rate |
$5,062.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,263.20
|
| Rate for Payer: Cash Price |
$3,197.40
|
| Rate for Payer: Cash Price |
$3,197.40
|
| Rate for Payer: Cigna Commercial |
$4,529.65
|
| Rate for Payer: First Health Commercial |
$4,796.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,796.10
|
| Rate for Payer: GEHA Commercial |
$3,730.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,796.10
|
| Rate for Payer: Multiplan All |
$4,849.39
|
| Rate for Payer: OMNI Networks Commercial |
$3,730.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,796.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,062.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,996.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,955.97
|
| Rate for Payer: Zelis Auto |
$2,131.60
|
|
|
IMPLT COMPONENT TIBIA SIZE 6 RIGHT
|
Facility
|
OP
|
$3,045.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$761.25 |
| Max. Negotiated Rate |
$2,892.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$2,588.25
|
| Rate for Payer: First Health Commercial |
$2,740.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,740.50
|
| Rate for Payer: GEHA Commercial |
$2,436.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,740.50
|
| Rate for Payer: Humana ChoiceCare |
$791.70
|
| Rate for Payer: Multiplan All |
$2,770.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,827.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,131.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,740.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,892.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,283.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,679.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$761.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,831.85
|
| Rate for Payer: Zelis Auto |
$1,218.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,522.50
|
|
|
IMPLT COMPONENT TIBIA SIZE 6 RIGHT
|
Facility
|
IP
|
$3,045.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.00 |
| Max. Negotiated Rate |
$2,892.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,436.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$2,588.25
|
| Rate for Payer: First Health Commercial |
$2,740.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,740.50
|
| Rate for Payer: GEHA Commercial |
$2,131.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,740.50
|
| Rate for Payer: Multiplan All |
$2,770.95
|
| Rate for Payer: OMNI Networks Commercial |
$2,131.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,740.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,892.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,283.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,831.85
|
| Rate for Payer: Zelis Auto |
$1,218.00
|
|
|
IMPLT COMPONENT TUBULAR .250 DIAMETER
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.20 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$390.40
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cigna Commercial |
$414.80
|
| Rate for Payer: First Health Commercial |
$439.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$439.20
|
| Rate for Payer: GEHA Commercial |
$341.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$439.20
|
| Rate for Payer: Multiplan All |
$444.08
|
| Rate for Payer: OMNI Networks Commercial |
$341.60
|
| Rate for Payer: One Health Plan PPO/POS |
$439.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$463.60
|
| Rate for Payer: Three Rivers Provider Network All |
$366.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$453.84
|
| Rate for Payer: Zelis Auto |
$195.20
|
|
|
IMPLT COMPONENT TUBULAR .250 DIAMETER
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cigna Commercial |
$414.80
|
| Rate for Payer: First Health Commercial |
$439.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$439.20
|
| Rate for Payer: GEHA Commercial |
$390.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$439.20
|
| Rate for Payer: Humana ChoiceCare |
$126.88
|
| Rate for Payer: Multiplan All |
$444.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$292.80
|
| Rate for Payer: OMNI Networks Commercial |
$341.60
|
| Rate for Payer: One Health Plan PPO/POS |
$439.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$463.60
|
| Rate for Payer: Three Rivers Provider Network All |
$366.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$429.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$453.84
|
| Rate for Payer: Zelis Auto |
$195.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$244.00
|
|
|
IMPLT COMPOSIX L/P MESH 10.2"X13.2
|
Facility
|
IP
|
$5,883.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,353.20 |
| Max. Negotiated Rate |
$5,588.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,706.40
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cigna Commercial |
$5,000.55
|
| Rate for Payer: First Health Commercial |
$5,294.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,294.70
|
| Rate for Payer: GEHA Commercial |
$4,118.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,294.70
|
| Rate for Payer: Multiplan All |
$5,353.53
|
| Rate for Payer: OMNI Networks Commercial |
$4,118.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,294.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,588.85
|
| Rate for Payer: Three Rivers Provider Network All |
$4,412.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,471.19
|
| Rate for Payer: Zelis Auto |
$2,353.20
|
|
|
IMPLT COMPOSIX L/P MESH 10.2"X13.2
|
Facility
|
OP
|
$5,883.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.75 |
| Max. Negotiated Rate |
$5,588.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,529.80
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cigna Commercial |
$5,000.55
|
| Rate for Payer: First Health Commercial |
$5,294.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,294.70
|
| Rate for Payer: GEHA Commercial |
$4,706.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,294.70
|
| Rate for Payer: Humana ChoiceCare |
$1,529.58
|
| Rate for Payer: Multiplan All |
$5,353.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,529.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,118.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,294.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,588.85
|
| Rate for Payer: Three Rivers Provider Network All |
$4,412.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,177.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,470.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,471.19
|
| Rate for Payer: Zelis Auto |
$2,353.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,941.50
|
|
|
IMPLT COMPRESSION PLATE
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.00 |
| Max. Negotiated Rate |
$2,112.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cigna Commercial |
$1,890.40
|
| Rate for Payer: First Health Commercial |
$2,001.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,001.60
|
| Rate for Payer: GEHA Commercial |
$1,779.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,001.60
|
| Rate for Payer: Humana ChoiceCare |
$578.24
|
| Rate for Payer: Multiplan All |
$2,023.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,334.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,001.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,957.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$556.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,068.32
|
| Rate for Payer: Zelis Auto |
$889.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,112.00
|
|
|
IMPLT COMPRESSION PLATE
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.60 |
| Max. Negotiated Rate |
$2,112.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,779.20
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cigna Commercial |
$1,890.40
|
| Rate for Payer: First Health Commercial |
$2,001.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,001.60
|
| Rate for Payer: GEHA Commercial |
$1,556.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,001.60
|
| Rate for Payer: Multiplan All |
$2,023.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,001.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,668.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,068.32
|
| Rate for Payer: Zelis Auto |
$889.60
|
|
|
IMPLT COMPR FT SCREW 3.5MINI 44MM
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,912.50
|
| Rate for Payer: First Health Commercial |
$2,025.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,025.00
|
| Rate for Payer: GEHA Commercial |
$1,800.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,025.00
|
| Rate for Payer: Humana ChoiceCare |
$585.00
|
| Rate for Payer: Multiplan All |
$2,047.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,350.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,575.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,025.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,137.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,687.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,980.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$562.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,092.50
|
| Rate for Payer: Zelis Auto |
$900.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,125.00
|
|
|
IMPLT COMPR FT SCREW 3.5MINI 44MM
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,912.50
|
| Rate for Payer: First Health Commercial |
$2,025.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,025.00
|
| Rate for Payer: GEHA Commercial |
$1,575.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,025.00
|
| Rate for Payer: Multiplan All |
$2,047.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,575.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,025.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,137.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,687.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,092.50
|
| Rate for Payer: Zelis Auto |
$900.00
|
|
|
IMPLT COMPR FT SCREW 3.5MINI 56MM
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,912.50
|
| Rate for Payer: First Health Commercial |
$2,025.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,025.00
|
| Rate for Payer: GEHA Commercial |
$1,800.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,025.00
|
| Rate for Payer: Humana ChoiceCare |
$585.00
|
| Rate for Payer: Multiplan All |
$2,047.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,350.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,575.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,025.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,137.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,687.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,980.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$562.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,092.50
|
| Rate for Payer: Zelis Auto |
$900.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,125.00
|
|
|
IMPLT COMPR FT SCREW 3.5MINI 56MM
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,912.50
|
| Rate for Payer: First Health Commercial |
$2,025.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,025.00
|
| Rate for Payer: GEHA Commercial |
$1,575.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,025.00
|
| Rate for Payer: Multiplan All |
$2,047.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,575.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,025.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,137.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,687.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,092.50
|
| Rate for Payer: Zelis Auto |
$900.00
|
|
|
IMPLT CONTOUR INJECTION STENT 6X22
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
7002425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.00 |
| Max. Negotiated Rate |
$893.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$799.00
|
| Rate for Payer: First Health Commercial |
$846.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.00
|
| Rate for Payer: GEHA Commercial |
$752.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.00
|
| Rate for Payer: Humana ChoiceCare |
$244.40
|
| Rate for Payer: Multiplan All |
$855.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$564.00
|
| Rate for Payer: OMNI Networks Commercial |
$658.00
|
| Rate for Payer: One Health Plan PPO/POS |
$846.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.00
|
| Rate for Payer: Three Rivers Provider Network All |
$705.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$827.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$235.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$874.20
|
| Rate for Payer: Zelis Auto |
$376.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$470.00
|
|
|
IMPLT CONTOUR INJECTION STENT 6X22
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
7002425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$376.00 |
| Max. Negotiated Rate |
$893.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$752.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$799.00
|
| Rate for Payer: First Health Commercial |
$846.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.00
|
| Rate for Payer: GEHA Commercial |
$658.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.00
|
| Rate for Payer: Multiplan All |
$855.40
|
| Rate for Payer: OMNI Networks Commercial |
$658.00
|
| Rate for Payer: One Health Plan PPO/POS |
$846.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.00
|
| Rate for Payer: Three Rivers Provider Network All |
$705.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$874.20
|
| Rate for Payer: Zelis Auto |
$376.00
|
|
|
IMPLT CONTOUR INJECTION STENT 6X24
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
7002426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT CONTOUR INJECTION STENT 6X24
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
7002426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT CORKSCREW FT, BCT SUTURETAPE
|
Facility
|
IP
|
$2,274.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.60 |
| Max. Negotiated Rate |
$2,160.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,819.20
|
| Rate for Payer: Cash Price |
$1,364.40
|
| Rate for Payer: Cash Price |
$1,364.40
|
| Rate for Payer: Cigna Commercial |
$1,932.90
|
| Rate for Payer: First Health Commercial |
$2,046.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,046.60
|
| Rate for Payer: GEHA Commercial |
$1,591.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,046.60
|
| Rate for Payer: Multiplan All |
$2,069.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,591.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,046.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,160.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,705.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,114.82
|
| Rate for Payer: Zelis Auto |
$909.60
|
|
|
IMPLT CORKSCREW FT, BCT SUTURETAPE
|
Facility
|
OP
|
$2,274.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.50 |
| Max. Negotiated Rate |
$2,160.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,364.40
|
| Rate for Payer: Cash Price |
$1,364.40
|
| Rate for Payer: Cash Price |
$1,364.40
|
| Rate for Payer: Cigna Commercial |
$1,932.90
|
| Rate for Payer: First Health Commercial |
$2,046.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,046.60
|
| Rate for Payer: GEHA Commercial |
$1,819.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,046.60
|
| Rate for Payer: Humana ChoiceCare |
$591.24
|
| Rate for Payer: Multiplan All |
$2,069.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,364.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,591.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,046.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,160.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,705.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,001.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$568.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,114.82
|
| Rate for Payer: Zelis Auto |
$909.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,137.00
|
|
|
IMPLT CORTEX SCREW 3.5 7182-1312
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.40
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
|
|
IMPLT CORTEX SCREW 3.5 7182-1312
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
|
|
IMPLT CORTEX SCREW 3.5 7182-1316
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.40
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
|
