|
IMPLT NAIL HUMERAL 8X240MM
|
Facility
|
IP
|
$5,541.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.40 |
| Max. Negotiated Rate |
$5,263.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,432.80
|
| Rate for Payer: Cash Price |
$3,324.60
|
| Rate for Payer: Cash Price |
$3,324.60
|
| Rate for Payer: Cigna Commercial |
$4,709.85
|
| Rate for Payer: First Health Commercial |
$4,986.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,986.90
|
| Rate for Payer: GEHA Commercial |
$3,878.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,986.90
|
| Rate for Payer: Multiplan All |
$5,042.31
|
| Rate for Payer: OMNI Networks Commercial |
$3,878.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,986.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,263.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,155.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,153.13
|
| Rate for Payer: Zelis Auto |
$2,216.40
|
|
|
IMPLT NAIL HUMERAL 8X240MM
|
Facility
|
OP
|
$5,541.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,385.25 |
| Max. Negotiated Rate |
$5,263.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,324.60
|
| Rate for Payer: Cash Price |
$3,324.60
|
| Rate for Payer: Cash Price |
$3,324.60
|
| Rate for Payer: Cigna Commercial |
$4,709.85
|
| Rate for Payer: First Health Commercial |
$4,986.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,986.90
|
| Rate for Payer: GEHA Commercial |
$4,432.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,986.90
|
| Rate for Payer: Humana ChoiceCare |
$1,440.66
|
| Rate for Payer: Multiplan All |
$5,042.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,324.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,878.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,986.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,263.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,155.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,876.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,385.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,153.13
|
| Rate for Payer: Zelis Auto |
$2,216.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,770.50
|
|
|
IMPLT NAIL HUMERAL 9X240MM
|
Facility
|
OP
|
$5,541.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,385.25 |
| Max. Negotiated Rate |
$5,263.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,324.60
|
| Rate for Payer: Cash Price |
$3,324.60
|
| Rate for Payer: Cash Price |
$3,324.60
|
| Rate for Payer: Cigna Commercial |
$4,709.85
|
| Rate for Payer: First Health Commercial |
$4,986.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,986.90
|
| Rate for Payer: GEHA Commercial |
$4,432.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,986.90
|
| Rate for Payer: Humana ChoiceCare |
$1,440.66
|
| Rate for Payer: Multiplan All |
$5,042.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,324.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,878.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,986.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,263.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,155.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,876.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,385.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,153.13
|
| Rate for Payer: Zelis Auto |
$2,216.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,770.50
|
|
|
IMPLT NAIL HUMERAL 9X240MM
|
Facility
|
IP
|
$5,541.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.40 |
| Max. Negotiated Rate |
$5,263.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,432.80
|
| Rate for Payer: Cash Price |
$3,324.60
|
| Rate for Payer: Cash Price |
$3,324.60
|
| Rate for Payer: Cigna Commercial |
$4,709.85
|
| Rate for Payer: First Health Commercial |
$4,986.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,986.90
|
| Rate for Payer: GEHA Commercial |
$3,878.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,986.90
|
| Rate for Payer: Multiplan All |
$5,042.31
|
| Rate for Payer: OMNI Networks Commercial |
$3,878.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,986.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,263.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,155.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,153.13
|
| Rate for Payer: Zelis Auto |
$2,216.40
|
|
|
IMPLT NAIL LONG GAMMA10X360MMX125DEGEE
|
Facility
|
OP
|
$7,613.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,903.25 |
| Max. Negotiated Rate |
$7,232.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,567.80
|
| Rate for Payer: Cash Price |
$4,567.80
|
| Rate for Payer: Cash Price |
$4,567.80
|
| Rate for Payer: Cigna Commercial |
$6,471.05
|
| Rate for Payer: First Health Commercial |
$6,851.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,851.70
|
| Rate for Payer: GEHA Commercial |
$6,090.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,851.70
|
| Rate for Payer: Humana ChoiceCare |
$1,979.38
|
| Rate for Payer: Multiplan All |
$6,927.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,567.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,329.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,851.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,232.35
|
| Rate for Payer: Three Rivers Provider Network All |
$5,709.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,699.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,903.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,080.09
|
| Rate for Payer: Zelis Auto |
$3,045.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,806.50
|
|
|
IMPLT NAIL LONG GAMMA10X360MMX125DEGEE
|
Facility
|
IP
|
$7,613.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.20 |
| Max. Negotiated Rate |
$7,232.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,090.40
|
| Rate for Payer: Cash Price |
$4,567.80
|
| Rate for Payer: Cash Price |
$4,567.80
|
| Rate for Payer: Cigna Commercial |
$6,471.05
|
| Rate for Payer: First Health Commercial |
$6,851.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,851.70
|
| Rate for Payer: GEHA Commercial |
$5,329.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,851.70
|
| Rate for Payer: Multiplan All |
$6,927.83
|
| Rate for Payer: OMNI Networks Commercial |
$5,329.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,851.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,232.35
|
| Rate for Payer: Three Rivers Provider Network All |
$5,709.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,080.09
|
| Rate for Payer: Zelis Auto |
$3,045.20
|
|
|
IMPLT NAIL RECONSTRUCTION RIGHT 09X380
|
Facility
|
IP
|
$6,573.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,629.20 |
| Max. Negotiated Rate |
$6,244.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,258.40
|
| Rate for Payer: Cash Price |
$3,943.80
|
| Rate for Payer: Cash Price |
$3,943.80
|
| Rate for Payer: Cigna Commercial |
$5,587.05
|
| Rate for Payer: First Health Commercial |
$5,915.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,915.70
|
| Rate for Payer: GEHA Commercial |
$4,601.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,915.70
|
| Rate for Payer: Multiplan All |
$5,981.43
|
| Rate for Payer: OMNI Networks Commercial |
$4,601.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,915.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,244.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,929.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,112.89
|
| Rate for Payer: Zelis Auto |
$2,629.20
|
|
|
IMPLT NAIL RECONSTRUCTION RIGHT 09X380
|
Facility
|
OP
|
$6,573.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,643.25 |
| Max. Negotiated Rate |
$6,244.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,943.80
|
| Rate for Payer: Cash Price |
$3,943.80
|
| Rate for Payer: Cash Price |
$3,943.80
|
| Rate for Payer: Cigna Commercial |
$5,587.05
|
| Rate for Payer: First Health Commercial |
$5,915.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,915.70
|
| Rate for Payer: GEHA Commercial |
$5,258.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,915.70
|
| Rate for Payer: Humana ChoiceCare |
$1,708.98
|
| Rate for Payer: Multiplan All |
$5,981.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,943.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,601.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,915.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,244.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,929.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,784.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,643.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,112.89
|
| Rate for Payer: Zelis Auto |
$2,629.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,286.50
|
|
|
IMPLT NAIL SUPRACONDYLAR 012X170MM
|
Facility
|
IP
|
$6,992.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,796.80 |
| Max. Negotiated Rate |
$6,642.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,593.60
|
| Rate for Payer: Cash Price |
$4,195.20
|
| Rate for Payer: Cash Price |
$4,195.20
|
| Rate for Payer: Cigna Commercial |
$5,943.20
|
| Rate for Payer: First Health Commercial |
$6,292.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,292.80
|
| Rate for Payer: GEHA Commercial |
$4,894.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,292.80
|
| Rate for Payer: Multiplan All |
$6,362.72
|
| Rate for Payer: OMNI Networks Commercial |
$4,894.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,292.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,642.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,244.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,502.56
|
| Rate for Payer: Zelis Auto |
$2,796.80
|
|
|
IMPLT NAIL SUPRACONDYLAR 012X170MM
|
Facility
|
OP
|
$6,992.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,748.00 |
| Max. Negotiated Rate |
$6,642.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,195.20
|
| Rate for Payer: Cash Price |
$4,195.20
|
| Rate for Payer: Cash Price |
$4,195.20
|
| Rate for Payer: Cigna Commercial |
$5,943.20
|
| Rate for Payer: First Health Commercial |
$6,292.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,292.80
|
| Rate for Payer: GEHA Commercial |
$5,593.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,292.80
|
| Rate for Payer: Humana ChoiceCare |
$1,817.92
|
| Rate for Payer: Multiplan All |
$6,362.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,195.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,894.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,292.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,642.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,244.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,152.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,748.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,502.56
|
| Rate for Payer: Zelis Auto |
$2,796.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,496.00
|
|
|
IMPLT NAIL TIBIAL STANDARD 09X300MM
|
Facility
|
IP
|
$5,208.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,083.20 |
| Max. Negotiated Rate |
$4,947.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,166.40
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cigna Commercial |
$4,426.80
|
| Rate for Payer: First Health Commercial |
$4,687.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,687.20
|
| Rate for Payer: GEHA Commercial |
$3,645.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,687.20
|
| Rate for Payer: Multiplan All |
$4,739.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,645.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,687.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,947.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,906.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,843.44
|
| Rate for Payer: Zelis Auto |
$2,083.20
|
|
|
IMPLT NAIL TIBIAL STANDARD 09X300MM
|
Facility
|
OP
|
$5,208.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.00 |
| Max. Negotiated Rate |
$4,947.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,124.80
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cigna Commercial |
$4,426.80
|
| Rate for Payer: First Health Commercial |
$4,687.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,687.20
|
| Rate for Payer: GEHA Commercial |
$4,166.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,687.20
|
| Rate for Payer: Humana ChoiceCare |
$1,354.08
|
| Rate for Payer: Multiplan All |
$4,739.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,124.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,645.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,687.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,947.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,906.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,583.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,302.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,843.44
|
| Rate for Payer: Zelis Auto |
$2,083.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,604.00
|
|
|
IMPLT NAIL TIBIAL STANDARD 09X315MM
|
Facility
|
OP
|
$4,097.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.25 |
| Max. Negotiated Rate |
$3,892.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,458.20
|
| Rate for Payer: Cash Price |
$2,458.20
|
| Rate for Payer: Cash Price |
$2,458.20
|
| Rate for Payer: Cigna Commercial |
$3,482.45
|
| Rate for Payer: First Health Commercial |
$3,687.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,687.30
|
| Rate for Payer: GEHA Commercial |
$3,277.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,687.30
|
| Rate for Payer: Humana ChoiceCare |
$1,065.22
|
| Rate for Payer: Multiplan All |
$3,728.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,458.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,867.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,687.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,892.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,072.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,605.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,024.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,810.21
|
| Rate for Payer: Zelis Auto |
$1,638.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,048.50
|
|
|
IMPLT NAIL TIBIAL STANDARD 09X315MM
|
Facility
|
IP
|
$4,097.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.80 |
| Max. Negotiated Rate |
$3,892.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,277.60
|
| Rate for Payer: Cash Price |
$2,458.20
|
| Rate for Payer: Cash Price |
$2,458.20
|
| Rate for Payer: Cigna Commercial |
$3,482.45
|
| Rate for Payer: First Health Commercial |
$3,687.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,687.30
|
| Rate for Payer: GEHA Commercial |
$2,867.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,687.30
|
| Rate for Payer: Multiplan All |
$3,728.27
|
| Rate for Payer: OMNI Networks Commercial |
$2,867.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,687.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,892.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,072.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,810.21
|
| Rate for Payer: Zelis Auto |
$1,638.80
|
|
|
IMPLT NAIL TIBIAL STANDARD 09X375MM
|
Facility
|
OP
|
$5,461.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.25 |
| Max. Negotiated Rate |
$5,187.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,276.60
|
| Rate for Payer: Cash Price |
$3,276.60
|
| Rate for Payer: Cash Price |
$3,276.60
|
| Rate for Payer: Cigna Commercial |
$4,641.85
|
| Rate for Payer: First Health Commercial |
$4,914.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,914.90
|
| Rate for Payer: GEHA Commercial |
$4,368.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,914.90
|
| Rate for Payer: Humana ChoiceCare |
$1,419.86
|
| Rate for Payer: Multiplan All |
$4,969.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,276.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,822.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,914.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,187.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,095.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,805.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,365.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,078.73
|
| Rate for Payer: Zelis Auto |
$2,184.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,730.50
|
|
|
IMPLT NAIL TIBIAL STANDARD 09X375MM
|
Facility
|
IP
|
$5,461.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.40 |
| Max. Negotiated Rate |
$5,187.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,368.80
|
| Rate for Payer: Cash Price |
$3,276.60
|
| Rate for Payer: Cash Price |
$3,276.60
|
| Rate for Payer: Cigna Commercial |
$4,641.85
|
| Rate for Payer: First Health Commercial |
$4,914.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,914.90
|
| Rate for Payer: GEHA Commercial |
$3,822.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,914.90
|
| Rate for Payer: Multiplan All |
$4,969.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,822.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,914.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,187.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,095.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,078.73
|
| Rate for Payer: Zelis Auto |
$2,184.40
|
|
|
IMPLT NAIL TIBIAL STANDARD 10X285MM
|
Facility
|
IP
|
$4,343.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.20 |
| Max. Negotiated Rate |
$4,125.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,474.40
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cigna Commercial |
$3,691.55
|
| Rate for Payer: First Health Commercial |
$3,908.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,908.70
|
| Rate for Payer: GEHA Commercial |
$3,040.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,908.70
|
| Rate for Payer: Multiplan All |
$3,952.13
|
| Rate for Payer: OMNI Networks Commercial |
$3,040.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,908.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,125.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,038.99
|
| Rate for Payer: Zelis Auto |
$1,737.20
|
|
|
IMPLT NAIL TIBIAL STANDARD 10X285MM
|
Facility
|
OP
|
$4,343.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.75 |
| Max. Negotiated Rate |
$4,125.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,605.80
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cigna Commercial |
$3,691.55
|
| Rate for Payer: First Health Commercial |
$3,908.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,908.70
|
| Rate for Payer: GEHA Commercial |
$3,474.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,908.70
|
| Rate for Payer: Humana ChoiceCare |
$1,129.18
|
| Rate for Payer: Multiplan All |
$3,952.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,605.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,040.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,908.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,125.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,257.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,821.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,085.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,038.99
|
| Rate for Payer: Zelis Auto |
$1,737.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,171.50
|
|
|
IMPLT NAIL TIBIAL STANDARD 10X300MM
|
Facility
|
OP
|
$4,343.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.75 |
| Max. Negotiated Rate |
$4,125.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,605.80
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cigna Commercial |
$3,691.55
|
| Rate for Payer: First Health Commercial |
$3,908.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,908.70
|
| Rate for Payer: GEHA Commercial |
$3,474.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,908.70
|
| Rate for Payer: Humana ChoiceCare |
$1,129.18
|
| Rate for Payer: Multiplan All |
$3,952.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,605.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,040.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,908.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,125.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,257.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,821.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,085.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,038.99
|
| Rate for Payer: Zelis Auto |
$1,737.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,171.50
|
|
|
IMPLT NAIL TIBIAL STANDARD 10X300MM
|
Facility
|
IP
|
$4,343.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.20 |
| Max. Negotiated Rate |
$4,125.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,474.40
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cigna Commercial |
$3,691.55
|
| Rate for Payer: First Health Commercial |
$3,908.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,908.70
|
| Rate for Payer: GEHA Commercial |
$3,040.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,908.70
|
| Rate for Payer: Multiplan All |
$3,952.13
|
| Rate for Payer: OMNI Networks Commercial |
$3,040.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,908.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,125.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,038.99
|
| Rate for Payer: Zelis Auto |
$1,737.20
|
|
|
IMPLT NAIL TIBIAL STANDARD 10X345MM
|
Facility
|
OP
|
$4,343.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.75 |
| Max. Negotiated Rate |
$4,125.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,605.80
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cigna Commercial |
$3,691.55
|
| Rate for Payer: First Health Commercial |
$3,908.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,908.70
|
| Rate for Payer: GEHA Commercial |
$3,474.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,908.70
|
| Rate for Payer: Humana ChoiceCare |
$1,129.18
|
| Rate for Payer: Multiplan All |
$3,952.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,605.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,040.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,908.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,125.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,257.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,821.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,085.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,038.99
|
| Rate for Payer: Zelis Auto |
$1,737.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,171.50
|
|
|
IMPLT NAIL TIBIAL STANDARD 10X345MM
|
Facility
|
IP
|
$4,343.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.20 |
| Max. Negotiated Rate |
$4,125.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,474.40
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cigna Commercial |
$3,691.55
|
| Rate for Payer: First Health Commercial |
$3,908.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,908.70
|
| Rate for Payer: GEHA Commercial |
$3,040.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,908.70
|
| Rate for Payer: Multiplan All |
$3,952.13
|
| Rate for Payer: OMNI Networks Commercial |
$3,040.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,908.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,125.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,038.99
|
| Rate for Payer: Zelis Auto |
$1,737.20
|
|
|
IMPLT NAIL TIBIAL STANDARD 11X315MM
|
Facility
|
OP
|
$4,343.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.75 |
| Max. Negotiated Rate |
$4,125.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,605.80
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cigna Commercial |
$3,691.55
|
| Rate for Payer: First Health Commercial |
$3,908.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,908.70
|
| Rate for Payer: GEHA Commercial |
$3,474.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,908.70
|
| Rate for Payer: Humana ChoiceCare |
$1,129.18
|
| Rate for Payer: Multiplan All |
$3,952.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,605.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,040.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,908.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,125.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,257.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,821.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,085.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,038.99
|
| Rate for Payer: Zelis Auto |
$1,737.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,171.50
|
|
|
IMPLT NAIL TIBIAL STANDARD 11X315MM
|
Facility
|
IP
|
$4,343.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.20 |
| Max. Negotiated Rate |
$4,125.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,474.40
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cash Price |
$2,605.80
|
| Rate for Payer: Cigna Commercial |
$3,691.55
|
| Rate for Payer: First Health Commercial |
$3,908.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,908.70
|
| Rate for Payer: GEHA Commercial |
$3,040.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,908.70
|
| Rate for Payer: Multiplan All |
$3,952.13
|
| Rate for Payer: OMNI Networks Commercial |
$3,040.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,908.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,125.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,038.99
|
| Rate for Payer: Zelis Auto |
$1,737.20
|
|
|
IMPLT NAIL TIBIAL STANDARD 11X330MM
|
Facility
|
IP
|
$5,208.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,083.20 |
| Max. Negotiated Rate |
$4,947.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,166.40
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cigna Commercial |
$4,426.80
|
| Rate for Payer: First Health Commercial |
$4,687.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,687.20
|
| Rate for Payer: GEHA Commercial |
$3,645.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,687.20
|
| Rate for Payer: Multiplan All |
$4,739.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,645.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,687.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,947.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,906.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,843.44
|
| Rate for Payer: Zelis Auto |
$2,083.20
|
|
