|
IMPLT NAIL FEMORAL 11X340MM
|
Facility
|
OP
|
$4,882.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.50 |
| Max. Negotiated Rate |
$4,637.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,929.20
|
| Rate for Payer: Cash Price |
$2,929.20
|
| Rate for Payer: Cash Price |
$2,929.20
|
| Rate for Payer: Cigna Commercial |
$4,149.70
|
| Rate for Payer: First Health Commercial |
$4,393.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,393.80
|
| Rate for Payer: GEHA Commercial |
$3,905.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,393.80
|
| Rate for Payer: Humana ChoiceCare |
$1,269.32
|
| Rate for Payer: Multiplan All |
$4,442.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,929.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,417.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,393.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,637.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,661.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,296.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,540.26
|
| Rate for Payer: Zelis Auto |
$1,952.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,441.00
|
|
|
IMPLT NAIL FEMORAL SYSTEM T2 09X260MM
|
Facility
|
OP
|
$5,016.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,254.00 |
| Max. Negotiated Rate |
$4,765.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,009.60
|
| Rate for Payer: Cash Price |
$3,009.60
|
| Rate for Payer: Cash Price |
$3,009.60
|
| Rate for Payer: Cigna Commercial |
$4,263.60
|
| Rate for Payer: First Health Commercial |
$4,514.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,514.40
|
| Rate for Payer: GEHA Commercial |
$4,012.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,514.40
|
| Rate for Payer: Humana ChoiceCare |
$1,304.16
|
| Rate for Payer: Multiplan All |
$4,564.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,009.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,511.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,514.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,765.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,762.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,414.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,254.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,664.88
|
| Rate for Payer: Zelis Auto |
$2,006.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,508.00
|
|
|
IMPLT NAIL FEMORAL SYSTEM T2 09X260MM
|
Facility
|
IP
|
$5,016.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,006.40 |
| Max. Negotiated Rate |
$4,765.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,012.80
|
| Rate for Payer: Cash Price |
$3,009.60
|
| Rate for Payer: Cash Price |
$3,009.60
|
| Rate for Payer: Cigna Commercial |
$4,263.60
|
| Rate for Payer: First Health Commercial |
$4,514.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,514.40
|
| Rate for Payer: GEHA Commercial |
$3,511.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,514.40
|
| Rate for Payer: Multiplan All |
$4,564.56
|
| Rate for Payer: OMNI Networks Commercial |
$3,511.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,514.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,765.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,762.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,664.88
|
| Rate for Payer: Zelis Auto |
$2,006.40
|
|
|
IMPLT NAIL FEMORAL SYSTEM T2 09X360MM
|
Facility
|
IP
|
$4,882.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,952.80 |
| Max. Negotiated Rate |
$4,637.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,905.60
|
| Rate for Payer: Cash Price |
$2,929.20
|
| Rate for Payer: Cash Price |
$2,929.20
|
| Rate for Payer: Cigna Commercial |
$4,149.70
|
| Rate for Payer: First Health Commercial |
$4,393.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,393.80
|
| Rate for Payer: GEHA Commercial |
$3,417.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,393.80
|
| Rate for Payer: Multiplan All |
$4,442.62
|
| Rate for Payer: OMNI Networks Commercial |
$3,417.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,393.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,637.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,661.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,540.26
|
| Rate for Payer: Zelis Auto |
$1,952.80
|
|
|
IMPLT NAIL FEMORAL SYSTEM T2 09X360MM
|
Facility
|
OP
|
$4,882.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.50 |
| Max. Negotiated Rate |
$4,637.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,929.20
|
| Rate for Payer: Cash Price |
$2,929.20
|
| Rate for Payer: Cash Price |
$2,929.20
|
| Rate for Payer: Cigna Commercial |
$4,149.70
|
| Rate for Payer: First Health Commercial |
$4,393.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,393.80
|
| Rate for Payer: GEHA Commercial |
$3,905.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,393.80
|
| Rate for Payer: Humana ChoiceCare |
$1,269.32
|
| Rate for Payer: Multiplan All |
$4,442.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,929.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,417.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,393.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,637.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,661.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,296.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,540.26
|
| Rate for Payer: Zelis Auto |
$1,952.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,441.00
|
|
|
IMPLT NAIL GAMMA 10X170MMX125DEGREE
|
Facility
|
OP
|
$5,131.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,282.75 |
| Max. Negotiated Rate |
$4,874.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,078.60
|
| Rate for Payer: Cash Price |
$3,078.60
|
| Rate for Payer: Cash Price |
$3,078.60
|
| Rate for Payer: Cigna Commercial |
$4,361.35
|
| Rate for Payer: First Health Commercial |
$4,617.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,617.90
|
| Rate for Payer: GEHA Commercial |
$4,104.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,617.90
|
| Rate for Payer: Humana ChoiceCare |
$1,334.06
|
| Rate for Payer: Multiplan All |
$4,669.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,078.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,591.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,617.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,874.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,848.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,515.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,282.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,771.83
|
| Rate for Payer: Zelis Auto |
$2,052.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,565.50
|
|
|
IMPLT NAIL GAMMA 10X170MMX125DEGREE
|
Facility
|
IP
|
$5,131.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,052.40 |
| Max. Negotiated Rate |
$4,874.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,104.80
|
| Rate for Payer: Cash Price |
$3,078.60
|
| Rate for Payer: Cash Price |
$3,078.60
|
| Rate for Payer: Cigna Commercial |
$4,361.35
|
| Rate for Payer: First Health Commercial |
$4,617.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,617.90
|
| Rate for Payer: GEHA Commercial |
$3,591.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,617.90
|
| Rate for Payer: Multiplan All |
$4,669.21
|
| Rate for Payer: OMNI Networks Commercial |
$3,591.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,617.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,874.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,848.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,771.83
|
| Rate for Payer: Zelis Auto |
$2,052.40
|
|
|
IMPLT NAIL GAMMA 10X300X125 LEFT
|
Facility
|
OP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.25 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$4,288.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Humana ChoiceCare |
$1,393.86
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,717.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,340.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,680.50
|
|
|
IMPLT NAIL GAMMA 10X300X125 LEFT
|
Facility
|
IP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.40 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,288.80
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$3,752.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
|
|
IMPLT NAIL GAMMA 10X300X125 RIGHT
|
Facility
|
OP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.25 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$4,288.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Humana ChoiceCare |
$1,393.86
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,717.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,340.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,680.50
|
|
|
IMPLT NAIL GAMMA 10X300X125 RIGHT
|
Facility
|
IP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.40 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,288.80
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$3,752.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
|
|
IMPLT NAIL GAMMA 10X320X125 LEFT
|
Facility
|
IP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.40 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,288.80
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$3,752.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
|
|
IMPLT NAIL GAMMA 10X320X125 LEFT
|
Facility
|
OP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.25 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$4,288.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Humana ChoiceCare |
$1,393.86
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,717.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,340.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,680.50
|
|
|
IMPLT NAIL GAMMA 10X340MMX125
|
Facility
|
OP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.25 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$4,288.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Humana ChoiceCare |
$1,393.86
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,717.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,340.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,680.50
|
|
|
IMPLT NAIL GAMMA 10X340MMX125
|
Facility
|
IP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.40 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,288.80
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$3,752.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
|
|
IMPLT NAIL GAMMA 10X340X120
|
Facility
|
IP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.40 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,288.80
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$3,752.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
|
|
IMPLT NAIL GAMMA 10X340X120
|
Facility
|
OP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.25 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$4,288.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Humana ChoiceCare |
$1,393.86
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,717.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,340.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,680.50
|
|
|
IMPLT NAIL GAMMA 10X340X120
|
Facility
|
OP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.25 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$4,288.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Humana ChoiceCare |
$1,393.86
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,717.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,340.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,680.50
|
|
|
IMPLT NAIL GAMMA 10X340X120
|
Facility
|
IP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.40 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,288.80
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$3,752.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
|
|
IMPLT NAIL GAMMA 10X340X125
|
Facility
|
IP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.40 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,288.80
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$3,752.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
|
|
IMPLT NAIL GAMMA 10X340X125
|
Facility
|
OP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.25 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$4,288.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Humana ChoiceCare |
$1,393.86
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,717.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,340.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,680.50
|
|
|
IMPLT NAIL GAMMA 10X360MMX125
|
Facility
|
OP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.25 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$4,288.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Humana ChoiceCare |
$1,393.86
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,717.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,340.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,680.50
|
|
|
IMPLT NAIL GAMMA 10X360MMX125
|
Facility
|
IP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.40 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,288.80
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$3,752.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
|
|
IMPLT NAIL GAMMA 10X360X120
|
Facility
|
IP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.40 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,288.80
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$3,752.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
|
|
IMPLT NAIL GAMMA 10X360X120
|
Facility
|
OP
|
$5,361.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.25 |
| Max. Negotiated Rate |
$5,092.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cash Price |
$3,216.60
|
| Rate for Payer: Cigna Commercial |
$4,556.85
|
| Rate for Payer: First Health Commercial |
$4,824.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,824.90
|
| Rate for Payer: GEHA Commercial |
$4,288.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,824.90
|
| Rate for Payer: Humana ChoiceCare |
$1,393.86
|
| Rate for Payer: Multiplan All |
$4,878.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,752.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,824.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,092.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,020.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,717.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,340.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,985.73
|
| Rate for Payer: Zelis Auto |
$2,144.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,680.50
|
|
