|
IMPLT NAIL GAMMA 11X320X125
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.20 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,006.40
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$3,505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
|
|
IMPLT NAIL GAMMA 11X320X125 RIGHT
|
Facility
|
OP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.00 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$4,006.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Humana ChoiceCare |
$1,302.08
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,004.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,407.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,504.00
|
|
|
IMPLT NAIL GAMMA 11X320X125 RIGHT
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.20 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,006.40
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$3,505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
|
|
IMPLT NAIL GAMMA 11X340MMX120 DEGREE
|
Facility
|
OP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.00 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$4,006.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Humana ChoiceCare |
$1,302.08
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,004.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,407.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,504.00
|
|
|
IMPLT NAIL GAMMA 11X340MMX120 DEGREE
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.20 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,006.40
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$3,505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
|
|
IMPLT NAIL GAMMA 11X340MMX120 DEGREE
|
Facility
|
OP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.00 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$4,006.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Humana ChoiceCare |
$1,302.08
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,004.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,407.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,504.00
|
|
|
IMPLT NAIL GAMMA 11X340MMX120 DEGREE
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.20 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,006.40
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$3,505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
|
|
IMPLT NAIL GAMMA 11X340X125 LEFT
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.20 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,006.40
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$3,505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
|
|
IMPLT NAIL GAMMA 11X340X125 LEFT
|
Facility
|
OP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.00 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$4,006.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Humana ChoiceCare |
$1,302.08
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,004.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,407.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,504.00
|
|
|
IMPLT NAIL GAMMA 11X360MMX120 DEGREE
|
Facility
|
OP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.00 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$4,006.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Humana ChoiceCare |
$1,302.08
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,004.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,407.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,504.00
|
|
|
IMPLT NAIL GAMMA 11X360MMX120 DEGREE
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.20 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,006.40
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$3,505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
|
|
IMPLT NAIL GAMMA 11X360MMX121 DEGREE
|
Facility
|
OP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.00 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$4,006.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Humana ChoiceCare |
$1,302.08
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,004.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,407.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,504.00
|
|
|
IMPLT NAIL GAMMA 11X360MMX121 DEGREE
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.20 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,006.40
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$3,505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
|
|
IMPLT NAIL GAMMA 11X360X125 LEFT
|
Facility
|
OP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.00 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$4,006.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Humana ChoiceCare |
$1,302.08
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,004.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,407.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,504.00
|
|
|
IMPLT NAIL GAMMA 11X360X125 LEFT
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.20 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,006.40
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$3,505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
|
|
IMPLT NAIL GAMMA 11X380MMX120 DEGREE
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.20 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,006.40
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$3,505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
|
|
IMPLT NAIL GAMMA 11X380MMX120 DEGREE
|
Facility
|
OP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.00 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$4,006.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Humana ChoiceCare |
$1,302.08
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,004.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,407.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,504.00
|
|
|
IMPLT NAIL GAMMA 11X380MMX122 DEGREE
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.20 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,006.40
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$3,505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
|
|
IMPLT NAIL GAMMA 11X380MMX122 DEGREE
|
Facility
|
OP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.00 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$4,006.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Humana ChoiceCare |
$1,302.08
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,004.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,407.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,504.00
|
|
|
IMPLT NAIL GAMMA 11X380X125 LEFT
|
Facility
|
OP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.00 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$4,006.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Humana ChoiceCare |
$1,302.08
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,004.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,407.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,504.00
|
|
|
IMPLT NAIL GAMMA 11X380X125 LEFT
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.20 |
| Max. Negotiated Rate |
$4,757.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,006.40
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cash Price |
$3,004.80
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: First Health Commercial |
$4,507.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,507.20
|
| Rate for Payer: GEHA Commercial |
$3,505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,507.20
|
| Rate for Payer: Multiplan All |
$4,557.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,505.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,507.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,757.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,657.44
|
| Rate for Payer: Zelis Auto |
$2,003.20
|
|
|
IMPLT NAIL GAMMA 3 S NAIL
|
Facility
|
OP
|
$4,160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.00 |
| Max. Negotiated Rate |
$3,952.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,496.00
|
| Rate for Payer: Cash Price |
$2,496.00
|
| Rate for Payer: Cash Price |
$2,496.00
|
| Rate for Payer: Cigna Commercial |
$3,536.00
|
| Rate for Payer: First Health Commercial |
$3,744.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,744.00
|
| Rate for Payer: GEHA Commercial |
$3,328.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,744.00
|
| Rate for Payer: Humana ChoiceCare |
$1,081.60
|
| Rate for Payer: Multiplan All |
$3,785.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,496.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,912.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,744.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,952.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,660.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,040.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,868.80
|
| Rate for Payer: Zelis Auto |
$1,664.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,080.00
|
|
|
IMPLT NAIL GAMMA 3 S NAIL
|
Facility
|
IP
|
$4,160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,664.00 |
| Max. Negotiated Rate |
$3,952.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,328.00
|
| Rate for Payer: Cash Price |
$2,496.00
|
| Rate for Payer: Cash Price |
$2,496.00
|
| Rate for Payer: Cigna Commercial |
$3,536.00
|
| Rate for Payer: First Health Commercial |
$3,744.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,744.00
|
| Rate for Payer: GEHA Commercial |
$2,912.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,744.00
|
| Rate for Payer: Multiplan All |
$3,785.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,912.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,744.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,952.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,120.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,868.80
|
| Rate for Payer: Zelis Auto |
$1,664.00
|
|
|
IMPLT NAIL GAMMA3 TROCHAR
|
Facility
|
OP
|
$4,336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.00 |
| Max. Negotiated Rate |
$4,119.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,601.60
|
| Rate for Payer: Cash Price |
$2,601.60
|
| Rate for Payer: Cash Price |
$2,601.60
|
| Rate for Payer: Cigna Commercial |
$3,685.60
|
| Rate for Payer: First Health Commercial |
$3,902.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,902.40
|
| Rate for Payer: GEHA Commercial |
$3,468.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,902.40
|
| Rate for Payer: Humana ChoiceCare |
$1,127.36
|
| Rate for Payer: Multiplan All |
$3,945.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,601.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,035.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,902.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,119.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,815.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,084.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,032.48
|
| Rate for Payer: Zelis Auto |
$1,734.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,168.00
|
|
|
IMPLT NAIL GAMMA3 TROCHAR
|
Facility
|
IP
|
$4,336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,734.40 |
| Max. Negotiated Rate |
$4,119.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,468.80
|
| Rate for Payer: Cash Price |
$2,601.60
|
| Rate for Payer: Cash Price |
$2,601.60
|
| Rate for Payer: Cigna Commercial |
$3,685.60
|
| Rate for Payer: First Health Commercial |
$3,902.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,902.40
|
| Rate for Payer: GEHA Commercial |
$3,035.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,902.40
|
| Rate for Payer: Multiplan All |
$3,945.76
|
| Rate for Payer: OMNI Networks Commercial |
$3,035.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,902.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,119.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,032.48
|
| Rate for Payer: Zelis Auto |
$1,734.40
|
|
