|
IMPLT JOINT TOE 21.5MM
|
Facility
|
OP
|
$6,090.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,522.50 |
| Max. Negotiated Rate |
$5,785.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,654.00
|
| Rate for Payer: Cash Price |
$3,654.00
|
| Rate for Payer: Cash Price |
$3,654.00
|
| Rate for Payer: Cigna Commercial |
$5,176.50
|
| Rate for Payer: First Health Commercial |
$5,481.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,481.00
|
| Rate for Payer: GEHA Commercial |
$4,872.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,481.00
|
| Rate for Payer: Humana ChoiceCare |
$1,583.40
|
| Rate for Payer: Multiplan All |
$5,541.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,654.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,263.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,481.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,785.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,567.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,359.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,522.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,663.70
|
| Rate for Payer: Zelis Auto |
$2,436.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,045.00
|
|
|
IMPLT JOINT TOE 21.5MM
|
Facility
|
IP
|
$6,090.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,436.00 |
| Max. Negotiated Rate |
$5,785.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,872.00
|
| Rate for Payer: Cash Price |
$3,654.00
|
| Rate for Payer: Cash Price |
$3,654.00
|
| Rate for Payer: Cigna Commercial |
$5,176.50
|
| Rate for Payer: First Health Commercial |
$5,481.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,481.00
|
| Rate for Payer: GEHA Commercial |
$4,263.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,481.00
|
| Rate for Payer: Multiplan All |
$5,541.90
|
| Rate for Payer: OMNI Networks Commercial |
$4,263.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,481.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,785.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,567.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,663.70
|
| Rate for Payer: Zelis Auto |
$2,436.00
|
|
|
IMPLT JUGRNOT 2.9MM
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$1,567.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,320.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,402.50
|
| Rate for Payer: First Health Commercial |
$1,485.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,485.00
|
| Rate for Payer: GEHA Commercial |
$1,155.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,485.00
|
| Rate for Payer: Multiplan All |
$1,501.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,155.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,485.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,567.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,237.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,534.50
|
| Rate for Payer: Zelis Auto |
$660.00
|
|
|
IMPLT JUGRNOT 2.9MM
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$1,567.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,402.50
|
| Rate for Payer: First Health Commercial |
$1,485.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,485.00
|
| Rate for Payer: GEHA Commercial |
$1,320.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,485.00
|
| Rate for Payer: Humana ChoiceCare |
$429.00
|
| Rate for Payer: Multiplan All |
$1,501.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$990.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,155.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,485.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,567.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,237.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,452.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,534.50
|
| Rate for Payer: Zelis Auto |
$660.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$825.00
|
|
|
IMPLT JUGRNT 1.0 MINI 3-0
|
Facility
|
IP
|
$1,634.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.60 |
| Max. Negotiated Rate |
$1,552.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,307.20
|
| Rate for Payer: Cash Price |
$980.40
|
| Rate for Payer: Cash Price |
$980.40
|
| Rate for Payer: Cigna Commercial |
$1,388.90
|
| Rate for Payer: First Health Commercial |
$1,470.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,470.60
|
| Rate for Payer: GEHA Commercial |
$1,143.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,470.60
|
| Rate for Payer: Multiplan All |
$1,486.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,143.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,470.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,552.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,225.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,519.62
|
| Rate for Payer: Zelis Auto |
$653.60
|
|
|
IMPLT JUGRNT 1.0 MINI 3-0
|
Facility
|
OP
|
$1,634.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.50 |
| Max. Negotiated Rate |
$1,552.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$980.40
|
| Rate for Payer: Cash Price |
$980.40
|
| Rate for Payer: Cash Price |
$980.40
|
| Rate for Payer: Cigna Commercial |
$1,388.90
|
| Rate for Payer: First Health Commercial |
$1,470.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,470.60
|
| Rate for Payer: GEHA Commercial |
$1,307.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,470.60
|
| Rate for Payer: Humana ChoiceCare |
$424.84
|
| Rate for Payer: Multiplan All |
$1,486.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$980.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,143.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,470.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,552.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,225.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,437.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$408.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,519.62
|
| Rate for Payer: Zelis Auto |
$653.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$817.00
|
|
|
IMPLT JUGRNT 1.4 SH SZ1
|
Facility
|
IP
|
$1,396.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.40 |
| Max. Negotiated Rate |
$1,326.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,116.80
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cigna Commercial |
$1,186.60
|
| Rate for Payer: First Health Commercial |
$1,256.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,256.40
|
| Rate for Payer: GEHA Commercial |
$977.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,256.40
|
| Rate for Payer: Multiplan All |
$1,270.36
|
| Rate for Payer: OMNI Networks Commercial |
$977.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,256.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,326.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,047.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,298.28
|
| Rate for Payer: Zelis Auto |
$558.40
|
|
|
IMPLT JUGRNT 1.4 SH SZ1
|
Facility
|
OP
|
$1,396.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.00 |
| Max. Negotiated Rate |
$1,326.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$837.60
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cigna Commercial |
$1,186.60
|
| Rate for Payer: First Health Commercial |
$1,256.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,256.40
|
| Rate for Payer: GEHA Commercial |
$1,116.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,256.40
|
| Rate for Payer: Humana ChoiceCare |
$362.96
|
| Rate for Payer: Multiplan All |
$1,270.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$837.60
|
| Rate for Payer: OMNI Networks Commercial |
$977.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,256.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,326.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,047.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,228.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$349.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,298.28
|
| Rate for Payer: Zelis Auto |
$558.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$698.00
|
|
|
IMPLT JUGRNT SZ 2 MAXIBRAID
|
Facility
|
OP
|
$1,396.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.00 |
| Max. Negotiated Rate |
$1,326.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$837.60
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cigna Commercial |
$1,186.60
|
| Rate for Payer: First Health Commercial |
$1,256.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,256.40
|
| Rate for Payer: GEHA Commercial |
$1,116.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,256.40
|
| Rate for Payer: Humana ChoiceCare |
$362.96
|
| Rate for Payer: Multiplan All |
$1,270.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$837.60
|
| Rate for Payer: OMNI Networks Commercial |
$977.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,256.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,326.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,047.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,228.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$349.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,298.28
|
| Rate for Payer: Zelis Auto |
$558.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$698.00
|
|
|
IMPLT JUGRNT SZ 2 MAXIBRAID
|
Facility
|
IP
|
$1,396.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.40 |
| Max. Negotiated Rate |
$1,326.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,116.80
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cigna Commercial |
$1,186.60
|
| Rate for Payer: First Health Commercial |
$1,256.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,256.40
|
| Rate for Payer: GEHA Commercial |
$977.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,256.40
|
| Rate for Payer: Multiplan All |
$1,270.36
|
| Rate for Payer: OMNI Networks Commercial |
$977.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,256.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,326.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,047.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,298.28
|
| Rate for Payer: Zelis Auto |
$558.40
|
|
|
IMPLT KIT ACCESSORY AMS700
|
Facility
|
OP
|
$3,372.60
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7002472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.15 |
| Max. Negotiated Rate |
$3,203.97 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,023.56
|
| Rate for Payer: Cash Price |
$2,023.56
|
| Rate for Payer: Cash Price |
$2,023.56
|
| Rate for Payer: Cigna Commercial |
$2,866.71
|
| Rate for Payer: First Health Commercial |
$3,035.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,035.34
|
| Rate for Payer: GEHA Commercial |
$2,698.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,035.34
|
| Rate for Payer: Humana ChoiceCare |
$876.88
|
| Rate for Payer: Multiplan All |
$3,069.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,023.56
|
| Rate for Payer: OMNI Networks Commercial |
$2,360.82
|
| Rate for Payer: One Health Plan PPO/POS |
$3,035.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,203.97
|
| Rate for Payer: Three Rivers Provider Network All |
$2,529.45
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,967.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$843.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,136.52
|
| Rate for Payer: Zelis Auto |
$1,349.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,686.30
|
|
|
IMPLT KIT ACCESSORY AMS700
|
Facility
|
IP
|
$3,372.60
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7002472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,349.04 |
| Max. Negotiated Rate |
$3,203.97 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,698.08
|
| Rate for Payer: Cash Price |
$2,023.56
|
| Rate for Payer: Cash Price |
$2,023.56
|
| Rate for Payer: Cigna Commercial |
$2,866.71
|
| Rate for Payer: First Health Commercial |
$3,035.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,035.34
|
| Rate for Payer: GEHA Commercial |
$2,360.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,035.34
|
| Rate for Payer: Multiplan All |
$3,069.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,360.82
|
| Rate for Payer: One Health Plan PPO/POS |
$3,035.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,203.97
|
| Rate for Payer: Three Rivers Provider Network All |
$2,529.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,136.52
|
| Rate for Payer: Zelis Auto |
$1,349.04
|
|
|
IMPLT KIT ACCESSORY AMS 800
|
Facility
|
IP
|
$4,193.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7002474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,677.20 |
| Max. Negotiated Rate |
$3,983.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,354.40
|
| Rate for Payer: Cash Price |
$2,515.80
|
| Rate for Payer: Cash Price |
$2,515.80
|
| Rate for Payer: Cigna Commercial |
$3,564.05
|
| Rate for Payer: First Health Commercial |
$3,773.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,773.70
|
| Rate for Payer: GEHA Commercial |
$2,935.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,773.70
|
| Rate for Payer: Multiplan All |
$3,815.63
|
| Rate for Payer: OMNI Networks Commercial |
$2,935.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,773.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,983.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,144.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,899.49
|
| Rate for Payer: Zelis Auto |
$1,677.20
|
|
|
IMPLT KIT ACCESSORY AMS 800
|
Facility
|
OP
|
$4,193.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7002474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,048.25 |
| Max. Negotiated Rate |
$3,983.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,515.80
|
| Rate for Payer: Cash Price |
$2,515.80
|
| Rate for Payer: Cash Price |
$2,515.80
|
| Rate for Payer: Cigna Commercial |
$3,564.05
|
| Rate for Payer: First Health Commercial |
$3,773.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,773.70
|
| Rate for Payer: GEHA Commercial |
$3,354.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,773.70
|
| Rate for Payer: Humana ChoiceCare |
$1,090.18
|
| Rate for Payer: Multiplan All |
$3,815.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,515.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,935.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,773.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,983.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,144.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,689.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,048.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,899.49
|
| Rate for Payer: Zelis Auto |
$1,677.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,096.50
|
|
|
IMPLT KIT BICEPTOR 7X15MM
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003180
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$410.25 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$984.60
|
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Humana ChoiceCare |
$426.66
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$984.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,444.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$410.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$820.50
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
IMPLT KIT BICEPTOR 7X15MM
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003180
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$447.99 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,148.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
IMPLT KIT BICEPTOR 7X25MM
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003183
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$447.99 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,148.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
IMPLT KIT BICEPTOR 7X25MM
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003183
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$410.25 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$984.60
|
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Humana ChoiceCare |
$426.66
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$984.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,444.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$410.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$820.50
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
IMPLT KIT BICEPTOR 8X15MM
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003181
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$410.25 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$984.60
|
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Humana ChoiceCare |
$426.66
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$984.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,444.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$410.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$820.50
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
IMPLT KIT BICEPTOR 8X15MM
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003181
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$447.99 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,148.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
IMPLT KIT BICEPTOR 8X25MM
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003184
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$410.25 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$984.60
|
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Humana ChoiceCare |
$426.66
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$984.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,444.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$410.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$820.50
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
IMPLT KIT BICEPTOR 8X25MM
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003184
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$447.99 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,148.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
IMPLT KIT BICEPTOR 9X15MM
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$410.25 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$984.60
|
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Humana ChoiceCare |
$426.66
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$984.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,444.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$410.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$820.50
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
IMPLT KIT BICEPTOR 9X15MM
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$447.99 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,148.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
IMPLT KIT BICEPTOR 9X25MM
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003185
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$410.25 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$984.60
|
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Humana ChoiceCare |
$426.66
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$984.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,444.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$410.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$820.50
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
