|
IMPLT FIBERTAK DOUBLELOAD SUTURE ANCH
|
Facility
|
OP
|
$2,227.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.75 |
| Max. Negotiated Rate |
$2,115.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,336.20
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$1,892.95
|
| Rate for Payer: First Health Commercial |
$2,004.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,004.30
|
| Rate for Payer: GEHA Commercial |
$1,781.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,004.30
|
| Rate for Payer: Humana ChoiceCare |
$579.02
|
| Rate for Payer: Multiplan All |
$2,026.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,336.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,558.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,004.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,115.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,670.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,959.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$556.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,071.11
|
| Rate for Payer: Zelis Auto |
$890.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,113.50
|
|
|
IMPLT FIBERTAK DOUBLELOAD SUTURE ANCH
|
Facility
|
IP
|
$2,227.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.80 |
| Max. Negotiated Rate |
$2,115.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,781.60
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$1,892.95
|
| Rate for Payer: First Health Commercial |
$2,004.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,004.30
|
| Rate for Payer: GEHA Commercial |
$1,558.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,004.30
|
| Rate for Payer: Multiplan All |
$2,026.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,558.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,004.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,115.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,670.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,071.11
|
| Rate for Payer: Zelis Auto |
$890.80
|
|
|
IMPLT FIBERTAK SUTURE ANCHOR
|
Facility
|
OP
|
$2,227.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.75 |
| Max. Negotiated Rate |
$2,115.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,336.20
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$1,892.95
|
| Rate for Payer: First Health Commercial |
$2,004.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,004.30
|
| Rate for Payer: GEHA Commercial |
$1,781.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,004.30
|
| Rate for Payer: Humana ChoiceCare |
$579.02
|
| Rate for Payer: Multiplan All |
$2,026.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,336.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,558.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,004.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,115.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,670.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,959.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$556.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,071.11
|
| Rate for Payer: Zelis Auto |
$890.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,113.50
|
|
|
IMPLT FIBERTAK SUTURE ANCHOR
|
Facility
|
IP
|
$2,227.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.80 |
| Max. Negotiated Rate |
$2,115.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,781.60
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$1,892.95
|
| Rate for Payer: First Health Commercial |
$2,004.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,004.30
|
| Rate for Payer: GEHA Commercial |
$1,558.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,004.30
|
| Rate for Payer: Multiplan All |
$2,026.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,558.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,004.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,115.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,670.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,071.11
|
| Rate for Payer: Zelis Auto |
$890.80
|
|
|
IMPLT FIBRTK DR LBRITPE WH/BL & TT W/G/B
|
Facility
|
IP
|
$2,719.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.60 |
| Max. Negotiated Rate |
$2,583.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,175.20
|
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cigna Commercial |
$2,311.15
|
| Rate for Payer: First Health Commercial |
$2,447.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,447.10
|
| Rate for Payer: GEHA Commercial |
$1,903.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,447.10
|
| Rate for Payer: Multiplan All |
$2,474.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,903.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,447.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,583.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,039.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,528.67
|
| Rate for Payer: Zelis Auto |
$1,087.60
|
|
|
IMPLT FIBRTK DR LBRITPE WH/BL & TT W/G/B
|
Facility
|
OP
|
$2,719.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.75 |
| Max. Negotiated Rate |
$2,583.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,631.40
|
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cigna Commercial |
$2,311.15
|
| Rate for Payer: First Health Commercial |
$2,447.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,447.10
|
| Rate for Payer: GEHA Commercial |
$2,175.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,447.10
|
| Rate for Payer: Humana ChoiceCare |
$706.94
|
| Rate for Payer: Multiplan All |
$2,474.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,631.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,903.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,447.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,583.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,039.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,392.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$679.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,528.67
|
| Rate for Payer: Zelis Auto |
$1,087.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,359.50
|
|
|
IMPLT FIBRTK DR LBRITPE WH/BL & TT WH/BL
|
Facility
|
OP
|
$2,719.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.75 |
| Max. Negotiated Rate |
$2,583.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,631.40
|
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cigna Commercial |
$2,311.15
|
| Rate for Payer: First Health Commercial |
$2,447.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,447.10
|
| Rate for Payer: GEHA Commercial |
$2,175.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,447.10
|
| Rate for Payer: Humana ChoiceCare |
$706.94
|
| Rate for Payer: Multiplan All |
$2,474.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,631.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,903.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,447.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,583.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,039.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,392.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$679.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,528.67
|
| Rate for Payer: Zelis Auto |
$1,087.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,359.50
|
|
|
IMPLT FIBRTK DR LBRITPE WH/BL & TT WH/BL
|
Facility
|
IP
|
$2,719.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.60 |
| Max. Negotiated Rate |
$2,583.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,175.20
|
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cigna Commercial |
$2,311.15
|
| Rate for Payer: First Health Commercial |
$2,447.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,447.10
|
| Rate for Payer: GEHA Commercial |
$1,903.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,447.10
|
| Rate for Payer: Multiplan All |
$2,474.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,903.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,447.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,583.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,039.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,528.67
|
| Rate for Payer: Zelis Auto |
$1,087.60
|
|
|
IMPLT FIBRTK DR LBRITPE WHITE & TT BL
|
Facility
|
IP
|
$2,719.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.60 |
| Max. Negotiated Rate |
$2,583.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,175.20
|
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cigna Commercial |
$2,311.15
|
| Rate for Payer: First Health Commercial |
$2,447.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,447.10
|
| Rate for Payer: GEHA Commercial |
$1,903.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,447.10
|
| Rate for Payer: Multiplan All |
$2,474.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,903.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,447.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,583.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,039.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,528.67
|
| Rate for Payer: Zelis Auto |
$1,087.60
|
|
|
IMPLT FIBRTK DR LBRITPE WHITE & TT BL
|
Facility
|
OP
|
$2,719.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.75 |
| Max. Negotiated Rate |
$2,583.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,631.40
|
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cigna Commercial |
$2,311.15
|
| Rate for Payer: First Health Commercial |
$2,447.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,447.10
|
| Rate for Payer: GEHA Commercial |
$2,175.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,447.10
|
| Rate for Payer: Humana ChoiceCare |
$706.94
|
| Rate for Payer: Multiplan All |
$2,474.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,631.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,903.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,447.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,583.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,039.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,392.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$679.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,528.67
|
| Rate for Payer: Zelis Auto |
$1,087.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,359.50
|
|
|
IMPLT FIBRTK RC DBLOAD TP BL/W BLK/W
|
Facility
|
OP
|
$2,445.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.25 |
| Max. Negotiated Rate |
$2,322.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cigna Commercial |
$2,078.25
|
| Rate for Payer: First Health Commercial |
$2,200.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,200.50
|
| Rate for Payer: GEHA Commercial |
$1,956.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,200.50
|
| Rate for Payer: Humana ChoiceCare |
$635.70
|
| Rate for Payer: Multiplan All |
$2,224.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,467.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,711.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,200.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,322.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,833.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,151.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$611.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,273.85
|
| Rate for Payer: Zelis Auto |
$978.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,222.50
|
|
|
IMPLT FIBRTK RC DBLOAD TP BL/W BLK/W
|
Facility
|
IP
|
$2,445.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.00 |
| Max. Negotiated Rate |
$2,322.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cigna Commercial |
$2,078.25
|
| Rate for Payer: First Health Commercial |
$2,200.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,200.50
|
| Rate for Payer: GEHA Commercial |
$1,711.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,200.50
|
| Rate for Payer: Multiplan All |
$2,224.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,711.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,200.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,322.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,833.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,273.85
|
| Rate for Payer: Zelis Auto |
$978.00
|
|
|
IMPLT FILTER SIMON NITINOL
|
Facility
|
IP
|
$4,400.00
|
|
|
Service Code
|
CPT C1880
|
| Hospital Charge Code |
7002395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,760.00 |
| Max. Negotiated Rate |
$4,180.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,520.00
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$3,740.00
|
| Rate for Payer: First Health Commercial |
$3,960.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,960.00
|
| Rate for Payer: GEHA Commercial |
$3,080.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,960.00
|
| Rate for Payer: Multiplan All |
$4,004.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,080.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,960.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,180.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,300.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,092.00
|
| Rate for Payer: Zelis Auto |
$1,760.00
|
|
|
IMPLT FILTER SIMON NITINOL
|
Facility
|
OP
|
$4,400.00
|
|
|
Service Code
|
CPT C1880
|
| Hospital Charge Code |
7002395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$4,180.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,640.00
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$3,740.00
|
| Rate for Payer: First Health Commercial |
$3,960.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,960.00
|
| Rate for Payer: GEHA Commercial |
$3,520.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,960.00
|
| Rate for Payer: Humana ChoiceCare |
$1,144.00
|
| Rate for Payer: Multiplan All |
$4,004.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,640.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,080.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,960.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,180.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,300.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,872.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,100.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,092.00
|
| Rate for Payer: Zelis Auto |
$1,760.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,200.00
|
|
|
IMPLT FIXATION BIOSW/VLK
|
Facility
|
IP
|
$3,858.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.20 |
| Max. Negotiated Rate |
$3,665.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,086.40
|
| Rate for Payer: Cash Price |
$2,314.80
|
| Rate for Payer: Cash Price |
$2,314.80
|
| Rate for Payer: Cigna Commercial |
$3,279.30
|
| Rate for Payer: First Health Commercial |
$3,472.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,472.20
|
| Rate for Payer: GEHA Commercial |
$2,700.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,472.20
|
| Rate for Payer: Multiplan All |
$3,510.78
|
| Rate for Payer: OMNI Networks Commercial |
$2,700.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,472.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,665.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,893.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,587.94
|
| Rate for Payer: Zelis Auto |
$1,543.20
|
|
|
IMPLT FIXATION BIOSW/VLK
|
Facility
|
OP
|
$3,858.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.50 |
| Max. Negotiated Rate |
$3,665.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,314.80
|
| Rate for Payer: Cash Price |
$2,314.80
|
| Rate for Payer: Cash Price |
$2,314.80
|
| Rate for Payer: Cigna Commercial |
$3,279.30
|
| Rate for Payer: First Health Commercial |
$3,472.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,472.20
|
| Rate for Payer: GEHA Commercial |
$3,086.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,472.20
|
| Rate for Payer: Humana ChoiceCare |
$1,003.08
|
| Rate for Payer: Multiplan All |
$3,510.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,314.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,700.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,472.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,665.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,893.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,395.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$964.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,587.94
|
| Rate for Payer: Zelis Auto |
$1,543.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,929.00
|
|
|
IMPLT FIXATION DEVICE OPEN
|
Facility
|
IP
|
$2,305.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7006424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.00 |
| Max. Negotiated Rate |
$2,189.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,844.00
|
| Rate for Payer: Cash Price |
$1,383.00
|
| Rate for Payer: Cash Price |
$1,383.00
|
| Rate for Payer: Cigna Commercial |
$1,959.25
|
| Rate for Payer: First Health Commercial |
$2,074.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,074.50
|
| Rate for Payer: GEHA Commercial |
$1,613.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,074.50
|
| Rate for Payer: Multiplan All |
$2,097.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,613.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,074.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,189.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,728.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,143.65
|
| Rate for Payer: Zelis Auto |
$922.00
|
|
|
IMPLT FIXATION DEVICE OPEN
|
Facility
|
OP
|
$2,305.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7006424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.25 |
| Max. Negotiated Rate |
$2,189.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,383.00
|
| Rate for Payer: Cash Price |
$1,383.00
|
| Rate for Payer: Cash Price |
$1,383.00
|
| Rate for Payer: Cigna Commercial |
$1,959.25
|
| Rate for Payer: First Health Commercial |
$2,074.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,074.50
|
| Rate for Payer: GEHA Commercial |
$1,844.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,074.50
|
| Rate for Payer: Humana ChoiceCare |
$599.30
|
| Rate for Payer: Multiplan All |
$2,097.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,383.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,613.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,074.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,189.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,728.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,028.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$576.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,143.65
|
| Rate for Payer: Zelis Auto |
$922.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,152.50
|
|
|
IMPLT FIXATION DEVICE STRAP25
|
Facility
|
OP
|
$2,283.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.75 |
| Max. Negotiated Rate |
$2,168.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,369.80
|
| Rate for Payer: Cash Price |
$1,369.80
|
| Rate for Payer: Cash Price |
$1,369.80
|
| Rate for Payer: Cigna Commercial |
$1,940.55
|
| Rate for Payer: First Health Commercial |
$2,054.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,054.70
|
| Rate for Payer: GEHA Commercial |
$1,826.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,054.70
|
| Rate for Payer: Humana ChoiceCare |
$593.58
|
| Rate for Payer: Multiplan All |
$2,077.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,369.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,054.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,168.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,712.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,009.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$570.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,123.19
|
| Rate for Payer: Zelis Auto |
$913.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,141.50
|
|
|
IMPLT FIXATION DEVICE STRAP25
|
Facility
|
IP
|
$2,283.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.20 |
| Max. Negotiated Rate |
$2,168.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,826.40
|
| Rate for Payer: Cash Price |
$1,369.80
|
| Rate for Payer: Cash Price |
$1,369.80
|
| Rate for Payer: Cigna Commercial |
$1,940.55
|
| Rate for Payer: First Health Commercial |
$2,054.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,054.70
|
| Rate for Payer: GEHA Commercial |
$1,598.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,054.70
|
| Rate for Payer: Multiplan All |
$2,077.53
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,054.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,168.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,712.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,123.19
|
| Rate for Payer: Zelis Auto |
$913.20
|
|
|
IMPLT FIXATION KNOTLESS MULTIFIX 5.5MM
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.00 |
| Max. Negotiated Rate |
$1,364.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cigna Commercial |
$1,220.60
|
| Rate for Payer: First Health Commercial |
$1,292.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,292.40
|
| Rate for Payer: GEHA Commercial |
$1,148.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,292.40
|
| Rate for Payer: Humana ChoiceCare |
$373.36
|
| Rate for Payer: Multiplan All |
$1,306.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$861.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,005.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,292.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,364.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,077.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,263.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$359.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,335.48
|
| Rate for Payer: Zelis Auto |
$574.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$718.00
|
|
|
IMPLT FIXATION KNOTLESS MULTIFIX 5.5MM
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.40 |
| Max. Negotiated Rate |
$1,364.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,148.80
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cigna Commercial |
$1,220.60
|
| Rate for Payer: First Health Commercial |
$1,292.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,292.40
|
| Rate for Payer: GEHA Commercial |
$1,005.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,292.40
|
| Rate for Payer: Multiplan All |
$1,306.76
|
| Rate for Payer: OMNI Networks Commercial |
$1,005.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,292.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,364.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,077.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,335.48
|
| Rate for Payer: Zelis Auto |
$574.40
|
|
|
IMPLT FLEX HINGE TOE SWANSON 25
|
Facility
|
OP
|
$2,942.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$735.50 |
| Max. Negotiated Rate |
$2,794.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,765.20
|
| Rate for Payer: Cash Price |
$1,765.20
|
| Rate for Payer: Cash Price |
$1,765.20
|
| Rate for Payer: Cigna Commercial |
$2,500.70
|
| Rate for Payer: First Health Commercial |
$2,647.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,647.80
|
| Rate for Payer: GEHA Commercial |
$2,353.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,647.80
|
| Rate for Payer: Humana ChoiceCare |
$764.92
|
| Rate for Payer: Multiplan All |
$2,677.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,765.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,059.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,647.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,794.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,206.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,588.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$735.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,736.06
|
| Rate for Payer: Zelis Auto |
$1,176.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,471.00
|
|
|
IMPLT FLEX HINGE TOE SWANSON 25
|
Facility
|
IP
|
$2,942.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.80 |
| Max. Negotiated Rate |
$2,794.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,353.60
|
| Rate for Payer: Cash Price |
$1,765.20
|
| Rate for Payer: Cash Price |
$1,765.20
|
| Rate for Payer: Cigna Commercial |
$2,500.70
|
| Rate for Payer: First Health Commercial |
$2,647.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,647.80
|
| Rate for Payer: GEHA Commercial |
$2,059.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,647.80
|
| Rate for Payer: Multiplan All |
$2,677.22
|
| Rate for Payer: OMNI Networks Commercial |
$2,059.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,647.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,794.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,206.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,736.06
|
| Rate for Payer: Zelis Auto |
$1,176.80
|
|
|
IMPLT FLOSEAL 5ML
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7001698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.60 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$851.20
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$744.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
|
