|
IMPLT CORTEX SCREW 3.5 7182-1316
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000277
|
|
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 CORTICAL SCREW
|
Facility
|
IP
|
$1,423.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.20 |
| Max. Negotiated Rate |
$1,351.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,138.40
|
| Rate for Payer: Cash Price |
$853.80
|
| Rate for Payer: Cash Price |
$853.80
|
| Rate for Payer: Cigna Commercial |
$1,209.55
|
| Rate for Payer: First Health Commercial |
$1,280.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,280.70
|
| Rate for Payer: GEHA Commercial |
$996.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,280.70
|
| Rate for Payer: Multiplan All |
$1,294.93
|
| Rate for Payer: OMNI Networks Commercial |
$996.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,280.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,351.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,067.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,323.39
|
| Rate for Payer: Zelis Auto |
$569.20
|
|
|
IMPLT CORTICAL SCREW
|
Facility
|
OP
|
$1,423.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.75 |
| Max. Negotiated Rate |
$1,351.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$853.80
|
| Rate for Payer: Cash Price |
$853.80
|
| Rate for Payer: Cash Price |
$853.80
|
| Rate for Payer: Cigna Commercial |
$1,209.55
|
| Rate for Payer: First Health Commercial |
$1,280.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,280.70
|
| Rate for Payer: GEHA Commercial |
$1,138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,280.70
|
| Rate for Payer: Humana ChoiceCare |
$369.98
|
| Rate for Payer: Multiplan All |
$1,294.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$853.80
|
| Rate for Payer: OMNI Networks Commercial |
$996.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,280.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,351.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,067.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,252.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$355.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,323.39
|
| Rate for Payer: Zelis Auto |
$569.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$711.50
|
|
|
IMPLT COUPLER PIN TO ROD
|
Facility
|
OP
|
$2,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.25 |
| Max. Negotiated Rate |
$2,193.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,385.40
|
| Rate for Payer: Cash Price |
$1,385.40
|
| Rate for Payer: Cash Price |
$1,385.40
|
| Rate for Payer: Cigna Commercial |
$1,962.65
|
| Rate for Payer: First Health Commercial |
$2,078.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,078.10
|
| Rate for Payer: GEHA Commercial |
$1,847.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,078.10
|
| Rate for Payer: Humana ChoiceCare |
$600.34
|
| Rate for Payer: Multiplan All |
$2,101.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,385.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,616.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,078.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,193.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,731.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,031.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$577.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,147.37
|
| Rate for Payer: Zelis Auto |
$923.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,154.50
|
|
|
IMPLT COUPLER PIN TO ROD
|
Facility
|
IP
|
$2,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.60 |
| Max. Negotiated Rate |
$2,193.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,847.20
|
| Rate for Payer: Cash Price |
$1,385.40
|
| Rate for Payer: Cash Price |
$1,385.40
|
| Rate for Payer: Cigna Commercial |
$1,962.65
|
| Rate for Payer: First Health Commercial |
$2,078.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,078.10
|
| Rate for Payer: GEHA Commercial |
$1,616.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,078.10
|
| Rate for Payer: Multiplan All |
$2,101.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,616.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,078.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,193.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,731.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,147.37
|
| Rate for Payer: Zelis Auto |
$923.60
|
|
|
IMPLT COUPLER PIN TO ROD INVERTED
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.00 |
| Max. Negotiated Rate |
$2,299.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cigna Commercial |
$2,057.00
|
| Rate for Payer: First Health Commercial |
$2,178.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,178.00
|
| Rate for Payer: GEHA Commercial |
$1,936.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,178.00
|
| Rate for Payer: Humana ChoiceCare |
$629.20
|
| Rate for Payer: Multiplan All |
$2,202.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,452.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,694.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,178.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,299.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,815.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,129.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$605.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,250.60
|
| Rate for Payer: Zelis Auto |
$968.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,210.00
|
|
|
IMPLT COUPLER PIN TO ROD INVERTED
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.00 |
| Max. Negotiated Rate |
$2,299.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cigna Commercial |
$2,057.00
|
| Rate for Payer: First Health Commercial |
$2,178.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,178.00
|
| Rate for Payer: GEHA Commercial |
$1,694.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,178.00
|
| Rate for Payer: Multiplan All |
$2,202.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,694.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,178.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,299.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,815.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,250.60
|
| Rate for Payer: Zelis Auto |
$968.00
|
|
|
IMPLT COUPLER ROD TO ROD
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.00 |
| Max. Negotiated Rate |
$2,299.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cigna Commercial |
$2,057.00
|
| Rate for Payer: First Health Commercial |
$2,178.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,178.00
|
| Rate for Payer: GEHA Commercial |
$1,936.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,178.00
|
| Rate for Payer: Humana ChoiceCare |
$629.20
|
| Rate for Payer: Multiplan All |
$2,202.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,452.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,694.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,178.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,299.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,815.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,129.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$605.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,250.60
|
| Rate for Payer: Zelis Auto |
$968.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,210.00
|
|
|
IMPLT COUPLER ROD TO ROD
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.00 |
| Max. Negotiated Rate |
$2,299.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cigna Commercial |
$2,057.00
|
| Rate for Payer: First Health Commercial |
$2,178.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,178.00
|
| Rate for Payer: GEHA Commercial |
$1,694.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,178.00
|
| Rate for Payer: Multiplan All |
$2,202.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,694.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,178.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,299.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,815.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,250.60
|
| Rate for Payer: Zelis Auto |
$968.00
|
|
|
IMPLT COUPLER TUBE TO ROD
|
Facility
|
OP
|
$2,420.00
|
|
| Hospital Charge Code |
7006539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.00 |
| Max. Negotiated Rate |
$2,299.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cigna Commercial |
$2,057.00
|
| Rate for Payer: First Health Commercial |
$2,178.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,178.00
|
| Rate for Payer: GEHA Commercial |
$1,936.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,178.00
|
| Rate for Payer: Humana ChoiceCare |
$629.20
|
| Rate for Payer: Multiplan All |
$2,202.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,452.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,694.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,178.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,299.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,815.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,129.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$605.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,250.60
|
| Rate for Payer: Zelis Auto |
$968.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,210.00
|
|
|
IMPLT COUPLER TUBE TO ROD
|
Facility
|
IP
|
$2,420.00
|
|
| Hospital Charge Code |
7006539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.00 |
| Max. Negotiated Rate |
$2,299.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cigna Commercial |
$2,057.00
|
| Rate for Payer: First Health Commercial |
$2,178.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,178.00
|
| Rate for Payer: GEHA Commercial |
$1,694.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,178.00
|
| Rate for Payer: Multiplan All |
$2,202.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,694.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,178.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,299.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,815.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,250.60
|
| Rate for Payer: Zelis Auto |
$968.00
|
|
|
IMPLT COVERED ESOPHAGEAL STENT
|
Facility
|
IP
|
$8,222.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,288.80 |
| Max. Negotiated Rate |
$7,810.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,577.60
|
| Rate for Payer: Cash Price |
$4,933.20
|
| Rate for Payer: Cash Price |
$4,933.20
|
| Rate for Payer: Cigna Commercial |
$6,988.70
|
| Rate for Payer: First Health Commercial |
$7,399.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,399.80
|
| Rate for Payer: GEHA Commercial |
$5,755.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,399.80
|
| Rate for Payer: Multiplan All |
$7,482.02
|
| Rate for Payer: OMNI Networks Commercial |
$5,755.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,399.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,810.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,166.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,646.46
|
| Rate for Payer: Zelis Auto |
$3,288.80
|
|
|
IMPLT COVERED ESOPHAGEAL STENT
|
Facility
|
OP
|
$8,222.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,055.50 |
| Max. Negotiated Rate |
$7,810.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,933.20
|
| Rate for Payer: Cash Price |
$4,933.20
|
| Rate for Payer: Cash Price |
$4,933.20
|
| Rate for Payer: Cigna Commercial |
$6,988.70
|
| Rate for Payer: First Health Commercial |
$7,399.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,399.80
|
| Rate for Payer: GEHA Commercial |
$6,577.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,399.80
|
| Rate for Payer: Humana ChoiceCare |
$2,137.72
|
| Rate for Payer: Multiplan All |
$7,482.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,933.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,755.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,399.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,810.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,166.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,235.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,055.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,646.46
|
| Rate for Payer: Zelis Auto |
$3,288.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,111.00
|
|
|
IMPLT COVERED ESOPHAGEAL STENT
|
Facility
|
OP
|
$8,222.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,055.50 |
| Max. Negotiated Rate |
$7,810.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,933.20
|
| Rate for Payer: Cash Price |
$4,933.20
|
| Rate for Payer: Cash Price |
$4,933.20
|
| Rate for Payer: Cigna Commercial |
$6,988.70
|
| Rate for Payer: First Health Commercial |
$7,399.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,399.80
|
| Rate for Payer: GEHA Commercial |
$6,577.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,399.80
|
| Rate for Payer: Humana ChoiceCare |
$2,137.72
|
| Rate for Payer: Multiplan All |
$7,482.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,933.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,755.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,399.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,810.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,166.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,235.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,055.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,646.46
|
| Rate for Payer: Zelis Auto |
$3,288.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,111.00
|
|
|
IMPLT COVERED ESOPHAGEAL STENT
|
Facility
|
IP
|
$8,222.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,288.80 |
| Max. Negotiated Rate |
$7,810.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,577.60
|
| Rate for Payer: Cash Price |
$4,933.20
|
| Rate for Payer: Cash Price |
$4,933.20
|
| Rate for Payer: Cigna Commercial |
$6,988.70
|
| Rate for Payer: First Health Commercial |
$7,399.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,399.80
|
| Rate for Payer: GEHA Commercial |
$5,755.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,399.80
|
| Rate for Payer: Multiplan All |
$7,482.02
|
| Rate for Payer: OMNI Networks Commercial |
$5,755.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,399.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,810.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,166.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,646.46
|
| Rate for Payer: Zelis Auto |
$3,288.80
|
|
|
IMPLT COVER HOLE SCREW REFLECTION
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$204.80
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: Zelis Auto |
$102.40
|
|
|
IMPLT COVER HOLE SCREW REFLECTION
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$204.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Humana ChoiceCare |
$66.56
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$153.60
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$225.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$64.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$128.00
|
|
|
IMPLT COVER HOLE THREADED INTERFIT
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7000281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$403.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Humana ChoiceCare |
$131.04
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$302.40
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$443.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: Zelis Auto |
$201.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$252.00
|
|
|
IMPLT COVER HOLE THREADED INTERFIT
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7000281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$403.20
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$352.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: Zelis Auto |
$201.60
|
|
|
IMPLT COVER SCREW HOLE
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$195.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Humana ChoiceCare |
$63.44
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$146.40
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$214.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$61.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$122.00
|
|
|
IMPLT COVER SCREW HOLE
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.20
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$170.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: Zelis Auto |
$97.60
|
|
|
IMPLT CRUCIATE FEMORAL #6 LEFT
|
Facility
|
IP
|
$7,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,890.00 |
| Max. Negotiated Rate |
$6,863.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,780.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cigna Commercial |
$6,141.25
|
| Rate for Payer: First Health Commercial |
$6,502.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,502.50
|
| Rate for Payer: GEHA Commercial |
$5,057.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,502.50
|
| Rate for Payer: Multiplan All |
$6,574.75
|
| Rate for Payer: OMNI Networks Commercial |
$5,057.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,502.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,863.75
|
| Rate for Payer: Three Rivers Provider Network All |
$5,418.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,719.25
|
| Rate for Payer: Zelis Auto |
$2,890.00
|
|
|
IMPLT CRUCIATE FEMORAL #6 LEFT
|
Facility
|
OP
|
$7,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,806.25 |
| Max. Negotiated Rate |
$6,863.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,335.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cigna Commercial |
$6,141.25
|
| Rate for Payer: First Health Commercial |
$6,502.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,502.50
|
| Rate for Payer: GEHA Commercial |
$5,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,502.50
|
| Rate for Payer: Humana ChoiceCare |
$1,878.50
|
| Rate for Payer: Multiplan All |
$6,574.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,335.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,057.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,502.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,863.75
|
| Rate for Payer: Three Rivers Provider Network All |
$5,418.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,358.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,806.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,719.25
|
| Rate for Payer: Zelis Auto |
$2,890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,612.50
|
|
|
IMPLT CRUCIATE FEMORAL #7 LEFT
|
Facility
|
OP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.75 |
| Max. Negotiated Rate |
$5,516.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,484.20
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cigna Commercial |
$4,935.95
|
| Rate for Payer: First Health Commercial |
$5,226.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,226.30
|
| Rate for Payer: GEHA Commercial |
$4,645.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,226.30
|
| Rate for Payer: Humana ChoiceCare |
$1,509.82
|
| Rate for Payer: Multiplan All |
$5,284.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,484.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,064.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,226.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,516.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,355.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,110.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,451.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,400.51
|
| Rate for Payer: Zelis Auto |
$2,322.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,903.50
|
|
|
IMPLT CRUCIATE FEMORAL #7 LEFT
|
Facility
|
IP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,322.80 |
| Max. Negotiated Rate |
$5,516.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,645.60
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cigna Commercial |
$4,935.95
|
| Rate for Payer: First Health Commercial |
$5,226.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,226.30
|
| Rate for Payer: GEHA Commercial |
$4,064.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,226.30
|
| Rate for Payer: Multiplan All |
$5,284.37
|
| Rate for Payer: OMNI Networks Commercial |
$4,064.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,226.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,516.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,355.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,400.51
|
| Rate for Payer: Zelis Auto |
$2,322.80
|
|
