|
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
|
|
|
IMPLT KIT CATH PIC INJ 5F DUAL
|
Facility
|
IP
|
$1,045.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
7001684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.00 |
| Max. Negotiated Rate |
$992.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$836.00
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cigna Commercial |
$888.25
|
| Rate for Payer: First Health Commercial |
$940.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$940.50
|
| Rate for Payer: GEHA Commercial |
$731.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$940.50
|
| Rate for Payer: Multiplan All |
$950.95
|
| Rate for Payer: OMNI Networks Commercial |
$731.50
|
| Rate for Payer: One Health Plan PPO/POS |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$992.75
|
| Rate for Payer: Three Rivers Provider Network All |
$783.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$971.85
|
| Rate for Payer: Zelis Auto |
$418.00
|
|
|
IMPLT KIT CATH PIC INJ 5F DUAL
|
Facility
|
OP
|
$1,045.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
7001684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.25 |
| Max. Negotiated Rate |
$992.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$627.00
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cigna Commercial |
$888.25
|
| Rate for Payer: First Health Commercial |
$940.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$940.50
|
| Rate for Payer: GEHA Commercial |
$836.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$940.50
|
| Rate for Payer: Humana ChoiceCare |
$271.70
|
| Rate for Payer: Multiplan All |
$950.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$627.00
|
| Rate for Payer: OMNI Networks Commercial |
$731.50
|
| Rate for Payer: One Health Plan PPO/POS |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$992.75
|
| Rate for Payer: Three Rivers Provider Network All |
$783.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$919.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$261.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$971.85
|
| Rate for Payer: Zelis Auto |
$418.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$522.50
|
|
|
IMPLT KIT CHEST TUBE PLEURA GUIDE DISP
|
Facility
|
IP
|
$507.00
|
|
| Hospital Charge Code |
70001805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$481.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.60
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cigna Commercial |
$430.95
|
| Rate for Payer: First Health Commercial |
$456.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$456.30
|
| Rate for Payer: GEHA Commercial |
$354.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$456.30
|
| Rate for Payer: Multiplan All |
$461.37
|
| Rate for Payer: OMNI Networks Commercial |
$354.90
|
| Rate for Payer: One Health Plan PPO/POS |
$456.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$481.65
|
| Rate for Payer: Three Rivers Provider Network All |
$380.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$471.51
|
| Rate for Payer: Zelis Auto |
$202.80
|
|
|
IMPLT KIT CHEST TUBE PLEURA GUIDE DISP
|
Facility
|
OP
|
$507.00
|
|
| Hospital Charge Code |
70001805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$481.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.20
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cigna Commercial |
$430.95
|
| Rate for Payer: First Health Commercial |
$456.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$456.30
|
| Rate for Payer: GEHA Commercial |
$405.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$456.30
|
| Rate for Payer: Humana ChoiceCare |
$131.82
|
| Rate for Payer: Multiplan All |
$461.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$304.20
|
| Rate for Payer: OMNI Networks Commercial |
$354.90
|
| Rate for Payer: One Health Plan PPO/POS |
$456.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$481.65
|
| Rate for Payer: Three Rivers Provider Network All |
$380.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$446.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$126.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$471.51
|
| Rate for Payer: Zelis Auto |
$202.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$253.50
|
|
|
IMPLT KIT JUGRNOT DISPOSABLE
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.00 |
| Max. Negotiated Rate |
$1,360.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cigna Commercial |
$1,217.20
|
| Rate for Payer: First Health Commercial |
$1,288.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,288.80
|
| Rate for Payer: GEHA Commercial |
$1,145.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,288.80
|
| Rate for Payer: Humana ChoiceCare |
$372.32
|
| Rate for Payer: Multiplan All |
$1,303.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$859.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,002.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,288.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,360.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,260.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$358.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,331.76
|
| Rate for Payer: Zelis Auto |
$572.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$716.00
|
|
|
IMPLT KIT JUGRNOT DISPOSABLE
|
Facility
|
IP
|
$1,432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.80 |
| Max. Negotiated Rate |
$1,360.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,145.60
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cigna Commercial |
$1,217.20
|
| Rate for Payer: First Health Commercial |
$1,288.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,288.80
|
| Rate for Payer: GEHA Commercial |
$1,002.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,288.80
|
| Rate for Payer: Multiplan All |
$1,303.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,002.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,288.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,360.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,331.76
|
| Rate for Payer: Zelis Auto |
$572.80
|
|
|
IMPLT KIT JUGRNT 1.5MM CURVED
|
Facility
|
IP
|
$1,427.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.80 |
| Max. Negotiated Rate |
$1,355.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,141.60
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cigna Commercial |
$1,212.95
|
| Rate for Payer: First Health Commercial |
$1,284.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,284.30
|
| Rate for Payer: GEHA Commercial |
$998.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,284.30
|
| Rate for Payer: Multiplan All |
$1,298.57
|
| Rate for Payer: OMNI Networks Commercial |
$998.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,284.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,355.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,070.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,327.11
|
| Rate for Payer: Zelis Auto |
$570.80
|
|
|
IMPLT KIT JUGRNT 1.5MM CURVED
|
Facility
|
OP
|
$1,427.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$356.75 |
| Max. Negotiated Rate |
$1,355.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$856.20
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cigna Commercial |
$1,212.95
|
| Rate for Payer: First Health Commercial |
$1,284.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,284.30
|
| Rate for Payer: GEHA Commercial |
$1,141.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,284.30
|
| Rate for Payer: Humana ChoiceCare |
$371.02
|
| Rate for Payer: Multiplan All |
$1,298.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.20
|
| Rate for Payer: OMNI Networks Commercial |
$998.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,284.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,355.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,070.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,255.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,327.11
|
| Rate for Payer: Zelis Auto |
$570.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$713.50
|
|
|
IMPLT KIT NAIL LNG TI R1.5 011X380MMX125
|
Facility
|
OP
|
$6,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$6,341.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna Commercial |
$5,673.75
|
| Rate for Payer: First Health Commercial |
$6,007.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,007.50
|
| Rate for Payer: GEHA Commercial |
$5,340.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,007.50
|
| Rate for Payer: Humana ChoiceCare |
$1,735.50
|
| Rate for Payer: Multiplan All |
$6,074.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,005.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,672.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,007.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,341.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,006.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,874.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,668.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,207.75
|
| Rate for Payer: Zelis Auto |
$2,670.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,337.50
|
|
|
IMPLT KIT NAIL LNG TI R1.5 011X380MMX125
|
Facility
|
IP
|
$6,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,670.00 |
| Max. Negotiated Rate |
$6,341.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,340.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna Commercial |
$5,673.75
|
| Rate for Payer: First Health Commercial |
$6,007.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,007.50
|
| Rate for Payer: GEHA Commercial |
$4,672.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,007.50
|
| Rate for Payer: Multiplan All |
$6,074.25
|
| Rate for Payer: OMNI Networks Commercial |
$4,672.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,007.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,341.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,006.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,207.75
|
| Rate for Payer: Zelis Auto |
$2,670.00
|
|
|
IMPLT KIT NAIL LONG R1/5 11X340MMX125
|
Facility
|
IP
|
$6,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,670.00 |
| Max. Negotiated Rate |
$6,341.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,340.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna Commercial |
$5,673.75
|
| Rate for Payer: First Health Commercial |
$6,007.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,007.50
|
| Rate for Payer: GEHA Commercial |
$4,672.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,007.50
|
| Rate for Payer: Multiplan All |
$6,074.25
|
| Rate for Payer: OMNI Networks Commercial |
$4,672.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,007.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,341.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,006.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,207.75
|
| Rate for Payer: Zelis Auto |
$2,670.00
|
|
|
IMPLT KIT NAIL LONG R1/5 11X340MMX125
|
Facility
|
OP
|
$6,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$6,341.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna Commercial |
$5,673.75
|
| Rate for Payer: First Health Commercial |
$6,007.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,007.50
|
| Rate for Payer: GEHA Commercial |
$5,340.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,007.50
|
| Rate for Payer: Humana ChoiceCare |
$1,735.50
|
| Rate for Payer: Multiplan All |
$6,074.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,005.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,672.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,007.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,341.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,006.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,874.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,668.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,207.75
|
| Rate for Payer: Zelis Auto |
$2,670.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,337.50
|
|
|
IMPLT KIT NAIL LONG R1.5 L 10X400MMX125
|
Facility
|
OP
|
$6,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$6,341.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna Commercial |
$5,673.75
|
| Rate for Payer: First Health Commercial |
$6,007.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,007.50
|
| Rate for Payer: GEHA Commercial |
$5,340.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,007.50
|
| Rate for Payer: Humana ChoiceCare |
$1,735.50
|
| Rate for Payer: Multiplan All |
$6,074.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,005.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,672.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,007.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,341.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,006.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,874.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,668.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,207.75
|
| Rate for Payer: Zelis Auto |
$2,670.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,337.50
|
|
|
IMPLT KIT NAIL LONG R1.5 L 10X400MMX125
|
Facility
|
IP
|
$6,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,670.00 |
| Max. Negotiated Rate |
$6,341.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,340.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna Commercial |
$5,673.75
|
| Rate for Payer: First Health Commercial |
$6,007.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,007.50
|
| Rate for Payer: GEHA Commercial |
$4,672.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,007.50
|
| Rate for Payer: Multiplan All |
$6,074.25
|
| Rate for Payer: OMNI Networks Commercial |
$4,672.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,007.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,341.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,006.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,207.75
|
| Rate for Payer: Zelis Auto |
$2,670.00
|
|
|
IMPLT KIT NAIL LONG R1/5 L 11X340MMX125
|
Facility
|
OP
|
$1,269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.25 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$1,015.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Humana ChoiceCare |
$329.94
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$761.40
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,116.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$317.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$634.50
|
|
|
IMPLT KIT NAIL LONG R1/5 L 11X340MMX125
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.60 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,015.20
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$888.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
|
|
IMPLT KIT NAIL LONG R1/5 L 11X360MMX125
|
Facility
|
OP
|
$6,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$6,341.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna Commercial |
$5,673.75
|
| Rate for Payer: First Health Commercial |
$6,007.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,007.50
|
| Rate for Payer: GEHA Commercial |
$5,340.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,007.50
|
| Rate for Payer: Humana ChoiceCare |
$1,735.50
|
| Rate for Payer: Multiplan All |
$6,074.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,005.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,672.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,007.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,341.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,006.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,874.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,668.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,207.75
|
| Rate for Payer: Zelis Auto |
$2,670.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,337.50
|
|
|
IMPLT KIT NAIL LONG R1/5 L 11X360MMX125
|
Facility
|
IP
|
$6,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,670.00 |
| Max. Negotiated Rate |
$6,341.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,340.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna Commercial |
$5,673.75
|
| Rate for Payer: First Health Commercial |
$6,007.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,007.50
|
| Rate for Payer: GEHA Commercial |
$4,672.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,007.50
|
| Rate for Payer: Multiplan All |
$6,074.25
|
| Rate for Payer: OMNI Networks Commercial |
$4,672.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,007.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,341.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,006.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,207.75
|
| Rate for Payer: Zelis Auto |
$2,670.00
|
|
|
IMPLT KIT NAIL LONG R1/5 L 11X380MMX125
|
Facility
|
OP
|
$1,269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.25 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$1,015.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Humana ChoiceCare |
$329.94
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$761.40
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,116.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$317.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$634.50
|
|
|
IMPLT KIT NAIL LONG R1/5 L 11X380MMX125
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.60 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,015.20
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$888.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
|
|
IMPLT KIT NAIL LONG R1/5 R 11X360MMX125
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.60 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,015.20
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$888.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
|
|
IMPLT KIT NAIL LONG R1/5 R 11X360MMX125
|
Facility
|
OP
|
$1,269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.25 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$1,015.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Humana ChoiceCare |
$329.94
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$761.40
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,116.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$317.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$634.50
|
|
|
IMPLT KIT NAIL LONG R1/5 R 11X380MMX125
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.60 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,015.20
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$888.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
|
|
IMPLT KIT NAIL LONG R1/5 R 11X380MMX125
|
Facility
|
OP
|
$1,269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.25 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$1,015.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Humana ChoiceCare |
$329.94
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$761.40
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,116.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$317.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$634.50
|
|
