|
IMPLT KIT V-PROBE ENDOCARE/CRYO
|
Facility
|
IP
|
$15,986.00
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
7002449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,394.40 |
| Max. Negotiated Rate |
$15,186.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,788.80
|
| Rate for Payer: Cash Price |
$9,591.60
|
| Rate for Payer: Cash Price |
$9,591.60
|
| Rate for Payer: Cigna Commercial |
$13,588.10
|
| Rate for Payer: First Health Commercial |
$14,387.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,387.40
|
| Rate for Payer: GEHA Commercial |
$11,190.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,387.40
|
| Rate for Payer: Multiplan All |
$14,547.26
|
| Rate for Payer: OMNI Networks Commercial |
$11,190.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14,387.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,186.70
|
| Rate for Payer: Three Rivers Provider Network All |
$11,989.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,866.98
|
| Rate for Payer: Zelis Auto |
$6,394.40
|
|
|
IMPLT KNOTLESS BUNCHING 1.8 FIBERTAK
|
Facility
|
OP
|
$2,010.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.50 |
| Max. Negotiated Rate |
$1,909.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,206.00
|
| Rate for Payer: Cash Price |
$1,206.00
|
| Rate for Payer: Cash Price |
$1,206.00
|
| Rate for Payer: Cigna Commercial |
$1,708.50
|
| Rate for Payer: First Health Commercial |
$1,809.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,809.00
|
| Rate for Payer: GEHA Commercial |
$1,608.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,809.00
|
| Rate for Payer: Humana ChoiceCare |
$522.60
|
| Rate for Payer: Multiplan All |
$1,829.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,206.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,407.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,809.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,909.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,507.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,768.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$502.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,869.30
|
| Rate for Payer: Zelis Auto |
$804.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,005.00
|
|
|
IMPLT KNOTLESS BUNCHING 1.8 FIBERTAK
|
Facility
|
IP
|
$2,010.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.00 |
| Max. Negotiated Rate |
$1,909.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,608.00
|
| Rate for Payer: Cash Price |
$1,206.00
|
| Rate for Payer: Cash Price |
$1,206.00
|
| Rate for Payer: Cigna Commercial |
$1,708.50
|
| Rate for Payer: First Health Commercial |
$1,809.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,809.00
|
| Rate for Payer: GEHA Commercial |
$1,407.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,809.00
|
| Rate for Payer: Multiplan All |
$1,829.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,407.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,809.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,909.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,507.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,869.30
|
| Rate for Payer: Zelis Auto |
$804.00
|
|
|
IMPLT K-WIRE 1.25MM 262.62
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$229.60
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
|
|
IMPLT K-WIRE 1.25MM 262.62
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.75 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Humana ChoiceCare |
$74.62
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$172.20
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$252.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$143.50
|
|
|
IMPLT K-WIRE 1.4
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$156.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Humana ChoiceCare |
$50.96
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$117.60
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$172.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$98.00
|
|
|
IMPLT K-WIRE 1.4
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$156.80
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$137.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: Zelis Auto |
$78.40
|
|
|
IMPLT K-WIRE 150MMX1.56MM TROC PNT
|
Facility
|
OP
|
$769.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.25 |
| Max. Negotiated Rate |
$730.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$461.40
|
| Rate for Payer: Cash Price |
$461.40
|
| Rate for Payer: Cash Price |
$461.40
|
| Rate for Payer: Cigna Commercial |
$653.65
|
| Rate for Payer: First Health Commercial |
$692.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$692.10
|
| Rate for Payer: GEHA Commercial |
$615.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$692.10
|
| Rate for Payer: Humana ChoiceCare |
$199.94
|
| Rate for Payer: Multiplan All |
$699.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$461.40
|
| Rate for Payer: OMNI Networks Commercial |
$538.30
|
| Rate for Payer: One Health Plan PPO/POS |
$692.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$730.55
|
| Rate for Payer: Three Rivers Provider Network All |
$576.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$676.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$192.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$715.17
|
| Rate for Payer: Zelis Auto |
$307.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$384.50
|
|
|
IMPLT K-WIRE 150MMX1.56MM TROC PNT
|
Facility
|
IP
|
$769.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$730.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$615.20
|
| Rate for Payer: Cash Price |
$461.40
|
| Rate for Payer: Cash Price |
$461.40
|
| Rate for Payer: Cigna Commercial |
$653.65
|
| Rate for Payer: First Health Commercial |
$692.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$692.10
|
| Rate for Payer: GEHA Commercial |
$538.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$692.10
|
| Rate for Payer: Multiplan All |
$699.79
|
| Rate for Payer: OMNI Networks Commercial |
$538.30
|
| Rate for Payer: One Health Plan PPO/POS |
$692.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$730.55
|
| Rate for Payer: Three Rivers Provider Network All |
$576.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$715.17
|
| Rate for Payer: Zelis Auto |
$307.60
|
|
|
IMPLT KWIRE 2.0X150
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.25 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$381.65
|
| Rate for Payer: First Health Commercial |
$404.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$404.10
|
| Rate for Payer: GEHA Commercial |
$359.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$404.10
|
| Rate for Payer: Humana ChoiceCare |
$116.74
|
| Rate for Payer: Multiplan All |
$408.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$269.40
|
| Rate for Payer: OMNI Networks Commercial |
$314.30
|
| Rate for Payer: One Health Plan PPO/POS |
$404.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$426.55
|
| Rate for Payer: Three Rivers Provider Network All |
$336.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$395.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$112.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$417.57
|
| Rate for Payer: Zelis Auto |
$179.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$224.50
|
|
|
IMPLT KWIRE 2.0X150
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.60 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$359.20
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$381.65
|
| Rate for Payer: First Health Commercial |
$404.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$404.10
|
| Rate for Payer: GEHA Commercial |
$314.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$404.10
|
| Rate for Payer: Multiplan All |
$408.59
|
| Rate for Payer: OMNI Networks Commercial |
$314.30
|
| Rate for Payer: One Health Plan PPO/POS |
$404.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$426.55
|
| Rate for Payer: Three Rivers Provider Network All |
$336.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$417.57
|
| Rate for Payer: Zelis Auto |
$179.60
|
|
|
IMPLT K-WIRE 2.8MM 10MM
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.20
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.00
|
|
|
IMPLT K-WIRE 2.8MM 10MM
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
|
|
IMPLT KWIRE 3.2X300
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.50 |
| Max. Negotiated Rate |
$283.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$253.30
|
| Rate for Payer: First Health Commercial |
$268.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$268.20
|
| Rate for Payer: GEHA Commercial |
$238.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$268.20
|
| Rate for Payer: Humana ChoiceCare |
$77.48
|
| Rate for Payer: Multiplan All |
$271.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$178.80
|
| Rate for Payer: OMNI Networks Commercial |
$208.60
|
| Rate for Payer: One Health Plan PPO/POS |
$268.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$283.10
|
| Rate for Payer: Three Rivers Provider Network All |
$223.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$262.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$277.14
|
| Rate for Payer: Zelis Auto |
$119.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.00
|
|
|
IMPLT KWIRE 3.2X300
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.20 |
| Max. Negotiated Rate |
$283.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$238.40
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$253.30
|
| Rate for Payer: First Health Commercial |
$268.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$268.20
|
| Rate for Payer: GEHA Commercial |
$208.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$268.20
|
| Rate for Payer: Multiplan All |
$271.18
|
| Rate for Payer: OMNI Networks Commercial |
$208.60
|
| Rate for Payer: One Health Plan PPO/POS |
$268.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$283.10
|
| Rate for Payer: Three Rivers Provider Network All |
$223.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$277.14
|
| Rate for Payer: Zelis Auto |
$119.20
|
|
|
IMPLT KWIRE 3.2X300
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$628.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$529.60
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cigna Commercial |
$562.70
|
| Rate for Payer: First Health Commercial |
$595.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$595.80
|
| Rate for Payer: GEHA Commercial |
$463.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$595.80
|
| Rate for Payer: Multiplan All |
$602.42
|
| Rate for Payer: OMNI Networks Commercial |
$463.40
|
| Rate for Payer: One Health Plan PPO/POS |
$595.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$628.90
|
| Rate for Payer: Three Rivers Provider Network All |
$496.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$615.66
|
| Rate for Payer: Zelis Auto |
$264.80
|
|
|
IMPLT KWIRE 3.2X300
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.50 |
| Max. Negotiated Rate |
$628.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$397.20
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cigna Commercial |
$562.70
|
| Rate for Payer: First Health Commercial |
$595.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$595.80
|
| Rate for Payer: GEHA Commercial |
$529.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$595.80
|
| Rate for Payer: Humana ChoiceCare |
$172.12
|
| Rate for Payer: Multiplan All |
$602.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$397.20
|
| Rate for Payer: OMNI Networks Commercial |
$463.40
|
| Rate for Payer: One Health Plan PPO/POS |
$595.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$628.90
|
| Rate for Payer: Three Rivers Provider Network All |
$496.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$582.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$615.66
|
| Rate for Payer: Zelis Auto |
$264.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$331.00
|
|
|
IMPLT LAG SCREW 10.75X75MM
|
Facility
|
OP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$2,021.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: First Health Commercial |
$1,915.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,915.20
|
| Rate for Payer: GEHA Commercial |
$1,702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,915.20
|
| Rate for Payer: Humana ChoiceCare |
$553.28
|
| Rate for Payer: Multiplan All |
$1,936.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,276.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,489.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,915.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,021.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,596.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,872.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$532.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,979.04
|
| Rate for Payer: Zelis Auto |
$851.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,064.00
|
|
|
IMPLT LAG SCREW 10.75X75MM
|
Facility
|
IP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.20 |
| Max. Negotiated Rate |
$2,021.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,702.40
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: First Health Commercial |
$1,915.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,915.20
|
| Rate for Payer: GEHA Commercial |
$1,489.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,915.20
|
| Rate for Payer: Multiplan All |
$1,936.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,489.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,915.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,021.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,596.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,979.04
|
| Rate for Payer: Zelis Auto |
$851.20
|
|
|
IMPLT LEAD
|
Facility
|
OP
|
$15,768.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
7006660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,942.00 |
| Max. Negotiated Rate |
$14,979.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,460.80
|
| Rate for Payer: Cash Price |
$9,460.80
|
| Rate for Payer: Cash Price |
$9,460.80
|
| Rate for Payer: Cigna Commercial |
$13,402.80
|
| Rate for Payer: First Health Commercial |
$14,191.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,191.20
|
| Rate for Payer: GEHA Commercial |
$12,614.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,191.20
|
| Rate for Payer: Humana ChoiceCare |
$4,099.68
|
| Rate for Payer: Multiplan All |
$14,348.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,460.80
|
| Rate for Payer: OMNI Networks Commercial |
$11,037.60
|
| Rate for Payer: One Health Plan PPO/POS |
$14,191.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,979.60
|
| Rate for Payer: Three Rivers Provider Network All |
$11,826.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13,875.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,942.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,664.24
|
| Rate for Payer: Zelis Auto |
$6,307.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,884.00
|
|
|
IMPLT LEAD
|
Facility
|
IP
|
$15,768.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
7006660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,307.20 |
| Max. Negotiated Rate |
$14,979.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,614.40
|
| Rate for Payer: Cash Price |
$9,460.80
|
| Rate for Payer: Cash Price |
$9,460.80
|
| Rate for Payer: Cigna Commercial |
$13,402.80
|
| Rate for Payer: First Health Commercial |
$14,191.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,191.20
|
| Rate for Payer: GEHA Commercial |
$11,037.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,191.20
|
| Rate for Payer: Multiplan All |
$14,348.88
|
| Rate for Payer: OMNI Networks Commercial |
$11,037.60
|
| Rate for Payer: One Health Plan PPO/POS |
$14,191.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,979.60
|
| Rate for Payer: Three Rivers Provider Network All |
$11,826.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,664.24
|
| Rate for Payer: Zelis Auto |
$6,307.20
|
|
|
IMPLT LEAD TINED SNS
|
Facility
|
OP
|
$11,160.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
7002326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,790.00 |
| Max. Negotiated Rate |
$10,602.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,696.00
|
| Rate for Payer: Cash Price |
$6,696.00
|
| Rate for Payer: Cash Price |
$6,696.00
|
| Rate for Payer: Cigna Commercial |
$9,486.00
|
| Rate for Payer: First Health Commercial |
$10,044.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,044.00
|
| Rate for Payer: GEHA Commercial |
$8,928.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,044.00
|
| Rate for Payer: Humana ChoiceCare |
$2,901.60
|
| Rate for Payer: Multiplan All |
$10,155.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,696.00
|
| Rate for Payer: OMNI Networks Commercial |
$7,812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$10,044.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,602.00
|
| Rate for Payer: Three Rivers Provider Network All |
$8,370.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,820.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,790.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,378.80
|
| Rate for Payer: Zelis Auto |
$4,464.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,580.00
|
|
|
IMPLT LEAD TINED SNS
|
Facility
|
IP
|
$11,160.00
|
|
|
Service Code
|
CPT C1778
|
| Hospital Charge Code |
7002326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,464.00 |
| Max. Negotiated Rate |
$10,602.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,928.00
|
| Rate for Payer: Cash Price |
$6,696.00
|
| Rate for Payer: Cash Price |
$6,696.00
|
| Rate for Payer: Cigna Commercial |
$9,486.00
|
| Rate for Payer: First Health Commercial |
$10,044.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,044.00
|
| Rate for Payer: GEHA Commercial |
$7,812.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,044.00
|
| Rate for Payer: Multiplan All |
$10,155.60
|
| Rate for Payer: OMNI Networks Commercial |
$7,812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$10,044.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,602.00
|
| Rate for Payer: Three Rivers Provider Network All |
$8,370.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,378.80
|
| Rate for Payer: Zelis Auto |
$4,464.00
|
|
|
IMPLT LIGATOR MULTIBAND
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7007052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$595.00
|
| Rate for Payer: First Health Commercial |
$630.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.00
|
| Rate for Payer: GEHA Commercial |
$560.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.00
|
| Rate for Payer: Humana ChoiceCare |
$182.00
|
| Rate for Payer: Multiplan All |
$637.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$420.00
|
| Rate for Payer: OMNI Networks Commercial |
$490.00
|
| Rate for Payer: One Health Plan PPO/POS |
$630.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.00
|
| Rate for Payer: Three Rivers Provider Network All |
$525.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$616.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$175.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.00
|
| Rate for Payer: Zelis Auto |
$280.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$350.00
|
|
|
IMPLT LIGATOR MULTIBAND
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7007052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$560.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$595.00
|
| Rate for Payer: First Health Commercial |
$630.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.00
|
| Rate for Payer: GEHA Commercial |
$490.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.00
|
| Rate for Payer: Multiplan All |
$637.00
|
| Rate for Payer: OMNI Networks Commercial |
$490.00
|
| Rate for Payer: One Health Plan PPO/POS |
$630.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.00
|
| Rate for Payer: Three Rivers Provider Network All |
$525.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.00
|
| Rate for Payer: Zelis Auto |
$280.00
|
|
