|
IMPLT EASY CLIP EZ15-12-12
|
Facility
|
OP
|
$5,887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.75 |
| Max. Negotiated Rate |
$5,592.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,532.20
|
| Rate for Payer: Cash Price |
$3,532.20
|
| Rate for Payer: Cash Price |
$3,532.20
|
| Rate for Payer: Cigna Commercial |
$5,003.95
|
| Rate for Payer: First Health Commercial |
$5,298.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,298.30
|
| Rate for Payer: GEHA Commercial |
$4,709.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,298.30
|
| Rate for Payer: Humana ChoiceCare |
$1,530.62
|
| Rate for Payer: Multiplan All |
$5,357.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,532.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,120.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,298.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,592.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,415.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,180.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,471.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,474.91
|
| Rate for Payer: Zelis Auto |
$2,354.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,943.50
|
|
|
IMPLT EASY CLIP EZ15-12-12
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,354.80 |
| Max. Negotiated Rate |
$5,592.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,709.60
|
| Rate for Payer: Cash Price |
$3,532.20
|
| Rate for Payer: Cash Price |
$3,532.20
|
| Rate for Payer: Cigna Commercial |
$5,003.95
|
| Rate for Payer: First Health Commercial |
$5,298.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,298.30
|
| Rate for Payer: GEHA Commercial |
$4,120.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,298.30
|
| Rate for Payer: Multiplan All |
$5,357.17
|
| Rate for Payer: OMNI Networks Commercial |
$4,120.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,298.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,592.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,415.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,474.91
|
| Rate for Payer: Zelis Auto |
$2,354.80
|
|
|
IMPLT ELBOW IMPLANT SYSTEM
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,247.00 |
| Max. Negotiated Rate |
$4,738.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,992.80
|
| Rate for Payer: Cash Price |
$2,992.80
|
| Rate for Payer: Cash Price |
$2,992.80
|
| Rate for Payer: Cigna Commercial |
$4,239.80
|
| Rate for Payer: First Health Commercial |
$4,489.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,489.20
|
| Rate for Payer: GEHA Commercial |
$3,990.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,489.20
|
| Rate for Payer: Humana ChoiceCare |
$1,296.88
|
| Rate for Payer: Multiplan All |
$4,539.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,992.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,491.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,489.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,738.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,741.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,389.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,247.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,638.84
|
| Rate for Payer: Zelis Auto |
$1,995.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,494.00
|
|
|
IMPLT ELBOW IMPLANT SYSTEM
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.20 |
| Max. Negotiated Rate |
$4,738.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,990.40
|
| Rate for Payer: Cash Price |
$2,992.80
|
| Rate for Payer: Cash Price |
$2,992.80
|
| Rate for Payer: Cigna Commercial |
$4,239.80
|
| Rate for Payer: First Health Commercial |
$4,489.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,489.20
|
| Rate for Payer: GEHA Commercial |
$3,491.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,489.20
|
| Rate for Payer: Multiplan All |
$4,539.08
|
| Rate for Payer: OMNI Networks Commercial |
$3,491.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,489.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,738.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,741.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,638.84
|
| Rate for Payer: Zelis Auto |
$1,995.20
|
|
|
IMPLT ENDOBUTTON CL 30MM
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$619.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Humana ChoiceCare |
$201.24
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$464.40
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$681.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$193.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$387.00
|
|
|
IMPLT ENDOBUTTON CL 30MM
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.60 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$619.20
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$541.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
|
|
IMPLT ETEX BETA-BSM 5CC
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,930.00 |
| Max. Negotiated Rate |
$4,583.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,860.00
|
| Rate for Payer: Cash Price |
$2,895.00
|
| Rate for Payer: Cash Price |
$2,895.00
|
| Rate for Payer: Cigna Commercial |
$4,101.25
|
| Rate for Payer: First Health Commercial |
$4,342.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,342.50
|
| Rate for Payer: GEHA Commercial |
$3,377.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,342.50
|
| Rate for Payer: Multiplan All |
$4,390.75
|
| Rate for Payer: OMNI Networks Commercial |
$3,377.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,342.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,583.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,618.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,487.25
|
| Rate for Payer: Zelis Auto |
$1,930.00
|
|
|
IMPLT ETEX BETA-BSM 5CC
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.25 |
| Max. Negotiated Rate |
$4,583.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,895.00
|
| Rate for Payer: Cash Price |
$2,895.00
|
| Rate for Payer: Cash Price |
$2,895.00
|
| Rate for Payer: Cigna Commercial |
$4,101.25
|
| Rate for Payer: First Health Commercial |
$4,342.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,342.50
|
| Rate for Payer: GEHA Commercial |
$3,860.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,342.50
|
| Rate for Payer: Humana ChoiceCare |
$1,254.50
|
| Rate for Payer: Multiplan All |
$4,390.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,895.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,377.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,342.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,583.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,618.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,246.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,487.25
|
| Rate for Payer: Zelis Auto |
$1,930.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,412.50
|
|
|
IMPLT ETEX GAMMA-BSM 5CC
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.25 |
| Max. Negotiated Rate |
$4,583.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,895.00
|
| Rate for Payer: Cash Price |
$2,895.00
|
| Rate for Payer: Cash Price |
$2,895.00
|
| Rate for Payer: Cigna Commercial |
$4,101.25
|
| Rate for Payer: First Health Commercial |
$4,342.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,342.50
|
| Rate for Payer: GEHA Commercial |
$3,860.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,342.50
|
| Rate for Payer: Humana ChoiceCare |
$1,254.50
|
| Rate for Payer: Multiplan All |
$4,390.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,895.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,377.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,342.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,583.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,618.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,246.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,487.25
|
| Rate for Payer: Zelis Auto |
$1,930.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,412.50
|
|
|
IMPLT ETEX GAMMA-BSM 5CC
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,930.00 |
| Max. Negotiated Rate |
$4,583.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,860.00
|
| Rate for Payer: Cash Price |
$2,895.00
|
| Rate for Payer: Cash Price |
$2,895.00
|
| Rate for Payer: Cigna Commercial |
$4,101.25
|
| Rate for Payer: First Health Commercial |
$4,342.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,342.50
|
| Rate for Payer: GEHA Commercial |
$3,377.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,342.50
|
| Rate for Payer: Multiplan All |
$4,390.75
|
| Rate for Payer: OMNI Networks Commercial |
$3,377.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,342.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,583.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,618.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,487.25
|
| Rate for Payer: Zelis Auto |
$1,930.00
|
|
|
IMPLT EXTENDER STEM 50MM
|
Facility
|
IP
|
$3,626.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,450.40 |
| Max. Negotiated Rate |
$3,444.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,900.80
|
| Rate for Payer: Cash Price |
$2,175.60
|
| Rate for Payer: Cash Price |
$2,175.60
|
| Rate for Payer: Cigna Commercial |
$3,082.10
|
| Rate for Payer: First Health Commercial |
$3,263.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,263.40
|
| Rate for Payer: GEHA Commercial |
$2,538.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,263.40
|
| Rate for Payer: Multiplan All |
$3,299.66
|
| Rate for Payer: OMNI Networks Commercial |
$2,538.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,263.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,444.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,719.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,372.18
|
| Rate for Payer: Zelis Auto |
$1,450.40
|
|
|
IMPLT EXTENDER STEM 50MM
|
Facility
|
OP
|
$3,626.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.50 |
| Max. Negotiated Rate |
$3,444.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,175.60
|
| Rate for Payer: Cash Price |
$2,175.60
|
| Rate for Payer: Cash Price |
$2,175.60
|
| Rate for Payer: Cigna Commercial |
$3,082.10
|
| Rate for Payer: First Health Commercial |
$3,263.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,263.40
|
| Rate for Payer: GEHA Commercial |
$2,900.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,263.40
|
| Rate for Payer: Humana ChoiceCare |
$942.76
|
| Rate for Payer: Multiplan All |
$3,299.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,175.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,538.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,263.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,444.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,719.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,190.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$906.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,372.18
|
| Rate for Payer: Zelis Auto |
$1,450.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,813.00
|
|
|
IMPLT EXTENDER STEM TRIATHLON 29MM
|
Facility
|
IP
|
$3,735.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.00 |
| Max. Negotiated Rate |
$3,548.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,988.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$3,174.75
|
| Rate for Payer: First Health Commercial |
$3,361.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,361.50
|
| Rate for Payer: GEHA Commercial |
$2,614.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,361.50
|
| Rate for Payer: Multiplan All |
$3,398.85
|
| Rate for Payer: OMNI Networks Commercial |
$2,614.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,361.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,548.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,801.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,473.55
|
| Rate for Payer: Zelis Auto |
$1,494.00
|
|
|
IMPLT EXTENDER STEM TRIATHLON 29MM
|
Facility
|
OP
|
$3,735.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.75 |
| Max. Negotiated Rate |
$3,548.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$3,174.75
|
| Rate for Payer: First Health Commercial |
$3,361.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,361.50
|
| Rate for Payer: GEHA Commercial |
$2,988.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,361.50
|
| Rate for Payer: Humana ChoiceCare |
$971.10
|
| Rate for Payer: Multiplan All |
$3,398.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,241.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,614.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,361.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,548.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,801.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,286.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$933.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,473.55
|
| Rate for Payer: Zelis Auto |
$1,494.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,867.50
|
|
|
IMPLT EYELET W/FORK 3.5X8.5MM DX SWIVEL
|
Facility
|
OP
|
$2,613.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.25 |
| Max. Negotiated Rate |
$2,482.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cigna Commercial |
$2,221.05
|
| Rate for Payer: First Health Commercial |
$2,351.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,351.70
|
| Rate for Payer: GEHA Commercial |
$2,090.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,351.70
|
| Rate for Payer: Humana ChoiceCare |
$679.38
|
| Rate for Payer: Multiplan All |
$2,377.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,567.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,829.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,351.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,482.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,959.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,299.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$653.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,430.09
|
| Rate for Payer: Zelis Auto |
$1,045.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,306.50
|
|
|
IMPLT EYELET W/FORK 3.5X8.5MM DX SWIVEL
|
Facility
|
IP
|
$2,613.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,045.20 |
| Max. Negotiated Rate |
$2,482.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,090.40
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cigna Commercial |
$2,221.05
|
| Rate for Payer: First Health Commercial |
$2,351.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,351.70
|
| Rate for Payer: GEHA Commercial |
$1,829.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,351.70
|
| Rate for Payer: Multiplan All |
$2,377.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,829.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,351.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,482.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,959.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,430.09
|
| Rate for Payer: Zelis Auto |
$1,045.20
|
|
|
IMPLT FAST FIX FLEX
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.25 |
| Max. Negotiated Rate |
$2,117.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,337.40
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cigna Commercial |
$1,894.65
|
| Rate for Payer: First Health Commercial |
$2,006.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,006.10
|
| Rate for Payer: GEHA Commercial |
$1,783.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,006.10
|
| Rate for Payer: Humana ChoiceCare |
$579.54
|
| Rate for Payer: Multiplan All |
$2,028.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,337.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,560.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,006.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,117.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,671.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,961.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$557.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,072.97
|
| Rate for Payer: Zelis Auto |
$891.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,114.50
|
|
|
IMPLT FAST FIX FLEX
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.60 |
| Max. Negotiated Rate |
$2,117.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,783.20
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cigna Commercial |
$1,894.65
|
| Rate for Payer: First Health Commercial |
$2,006.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,006.10
|
| Rate for Payer: GEHA Commercial |
$1,560.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,006.10
|
| Rate for Payer: Multiplan All |
$2,028.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,560.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,006.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,117.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,671.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,072.97
|
| Rate for Payer: Zelis Auto |
$891.60
|
|
|
IMPLT FAST FIX FLEX REVERSED CURVED
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.60 |
| Max. Negotiated Rate |
$2,117.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,783.20
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cigna Commercial |
$1,894.65
|
| Rate for Payer: First Health Commercial |
$2,006.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,006.10
|
| Rate for Payer: GEHA Commercial |
$1,560.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,006.10
|
| Rate for Payer: Multiplan All |
$2,028.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,560.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,006.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,117.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,671.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,072.97
|
| Rate for Payer: Zelis Auto |
$891.60
|
|
|
IMPLT FAST FIX FLEX REVERSED CURVED
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.25 |
| Max. Negotiated Rate |
$2,117.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,337.40
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cigna Commercial |
$1,894.65
|
| Rate for Payer: First Health Commercial |
$2,006.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,006.10
|
| Rate for Payer: GEHA Commercial |
$1,783.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,006.10
|
| Rate for Payer: Humana ChoiceCare |
$579.54
|
| Rate for Payer: Multiplan All |
$2,028.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,337.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,560.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,006.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,117.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,671.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,961.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$557.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,072.97
|
| Rate for Payer: Zelis Auto |
$891.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,114.50
|
|
|
IMPLT FEM COMPONENT 8
|
Facility
|
IP
|
$6,150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001553
|
|
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 FEM COMPONENT 8
|
Facility
|
OP
|
$6,150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001553
|
|
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 FEM DISTAL AUG RIGHT 5MM #3
|
Facility
|
IP
|
$3,618.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.20 |
| Max. Negotiated Rate |
$3,437.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,894.40
|
| Rate for Payer: Cash Price |
$2,170.80
|
| Rate for Payer: Cash Price |
$2,170.80
|
| Rate for Payer: Cigna Commercial |
$3,075.30
|
| Rate for Payer: First Health Commercial |
$3,256.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,256.20
|
| Rate for Payer: GEHA Commercial |
$2,532.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,256.20
|
| Rate for Payer: Multiplan All |
$3,292.38
|
| Rate for Payer: OMNI Networks Commercial |
$2,532.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,256.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,437.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,713.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,364.74
|
| Rate for Payer: Zelis Auto |
$1,447.20
|
|
|
IMPLT FEM DISTAL AUG RIGHT 5MM #3
|
Facility
|
OP
|
$3,618.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.50 |
| Max. Negotiated Rate |
$3,437.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,170.80
|
| Rate for Payer: Cash Price |
$2,170.80
|
| Rate for Payer: Cash Price |
$2,170.80
|
| Rate for Payer: Cigna Commercial |
$3,075.30
|
| Rate for Payer: First Health Commercial |
$3,256.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,256.20
|
| Rate for Payer: GEHA Commercial |
$2,894.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,256.20
|
| Rate for Payer: Humana ChoiceCare |
$940.68
|
| Rate for Payer: Multiplan All |
$3,292.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,170.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,532.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,256.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,437.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,713.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,183.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$904.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,364.74
|
| Rate for Payer: Zelis Auto |
$1,447.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,809.00
|
|
|
IMPLT FEMORAL CEMENTED PRIMARY RT LARGE
|
Facility
|
IP
|
$12,209.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,883.60 |
| Max. Negotiated Rate |
$11,598.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,767.20
|
| Rate for Payer: Cash Price |
$7,325.40
|
| Rate for Payer: Cash Price |
$7,325.40
|
| Rate for Payer: Cigna Commercial |
$10,377.65
|
| Rate for Payer: First Health Commercial |
$10,988.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,988.10
|
| Rate for Payer: GEHA Commercial |
$8,546.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,988.10
|
| Rate for Payer: Multiplan All |
$11,110.19
|
| Rate for Payer: OMNI Networks Commercial |
$8,546.30
|
| Rate for Payer: One Health Plan PPO/POS |
$10,988.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,598.55
|
| Rate for Payer: Three Rivers Provider Network All |
$9,156.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,354.37
|
| Rate for Payer: Zelis Auto |
$4,883.60
|
|
