|
IMPLT NAIL TIBIAL STANDARD 11X330MM
|
Facility
|
OP
|
$5,208.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006201
|
|
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 11X390MM
|
Facility
|
OP
|
$1,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$260.25 |
| Max. Negotiated Rate |
$988.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna Commercial |
$884.85
|
| Rate for Payer: First Health Commercial |
$936.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$936.90
|
| Rate for Payer: GEHA Commercial |
$832.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$936.90
|
| Rate for Payer: Humana ChoiceCare |
$270.66
|
| Rate for Payer: Multiplan All |
$947.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$624.60
|
| Rate for Payer: OMNI Networks Commercial |
$728.70
|
| Rate for Payer: One Health Plan PPO/POS |
$936.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$988.95
|
| Rate for Payer: Three Rivers Provider Network All |
$780.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$916.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$260.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$968.13
|
| Rate for Payer: Zelis Auto |
$416.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$520.50
|
|
|
IMPLT NAIL TIBIAL STANDARD 11X390MM
|
Facility
|
IP
|
$1,041.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.40 |
| Max. Negotiated Rate |
$988.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$832.80
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna Commercial |
$884.85
|
| Rate for Payer: First Health Commercial |
$936.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$936.90
|
| Rate for Payer: GEHA Commercial |
$728.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$936.90
|
| Rate for Payer: Multiplan All |
$947.31
|
| Rate for Payer: OMNI Networks Commercial |
$728.70
|
| Rate for Payer: One Health Plan PPO/POS |
$936.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$988.95
|
| Rate for Payer: Three Rivers Provider Network All |
$780.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$968.13
|
| Rate for Payer: Zelis Auto |
$416.40
|
|
|
IMPLT NAIL TIBIAL STANDARD 12X300MM
|
Facility
|
OP
|
$5,208.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006605
|
|
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 12X300MM
|
Facility
|
IP
|
$5,208.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006605
|
|
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 12X360MM
|
Facility
|
OP
|
$5,208.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000289
|
|
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 12X360MM
|
Facility
|
IP
|
$5,208.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000289
|
|
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 TROCHANTERIC 10MMX34CM
|
Facility
|
OP
|
$7,032.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,758.00 |
| Max. Negotiated Rate |
$6,680.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,219.20
|
| Rate for Payer: Cash Price |
$4,219.20
|
| Rate for Payer: Cash Price |
$4,219.20
|
| Rate for Payer: Cigna Commercial |
$5,977.20
|
| Rate for Payer: First Health Commercial |
$6,328.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,328.80
|
| Rate for Payer: GEHA Commercial |
$5,625.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,328.80
|
| Rate for Payer: Humana ChoiceCare |
$1,828.32
|
| Rate for Payer: Multiplan All |
$6,399.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,219.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,922.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,328.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,680.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,274.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,188.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,758.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,539.76
|
| Rate for Payer: Zelis Auto |
$2,812.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,516.00
|
|
|
IMPLT NAIL TROCHANTERIC 10MMX34CM
|
Facility
|
IP
|
$7,032.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,812.80 |
| Max. Negotiated Rate |
$6,680.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,625.60
|
| Rate for Payer: Cash Price |
$4,219.20
|
| Rate for Payer: Cash Price |
$4,219.20
|
| Rate for Payer: Cigna Commercial |
$5,977.20
|
| Rate for Payer: First Health Commercial |
$6,328.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,328.80
|
| Rate for Payer: GEHA Commercial |
$4,922.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,328.80
|
| Rate for Payer: Multiplan All |
$6,399.12
|
| Rate for Payer: OMNI Networks Commercial |
$4,922.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,328.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,680.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,274.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,539.76
|
| Rate for Payer: Zelis Auto |
$2,812.80
|
|
|
IMPLT NAIL TROCHANTRIC GRIP LARGE
|
Facility
|
IP
|
$3,423.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,369.20 |
| Max. Negotiated Rate |
$3,251.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,738.40
|
| Rate for Payer: Cash Price |
$2,053.80
|
| Rate for Payer: Cash Price |
$2,053.80
|
| Rate for Payer: Cigna Commercial |
$2,909.55
|
| Rate for Payer: First Health Commercial |
$3,080.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,080.70
|
| Rate for Payer: GEHA Commercial |
$2,396.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,080.70
|
| Rate for Payer: Multiplan All |
$3,114.93
|
| Rate for Payer: OMNI Networks Commercial |
$2,396.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,080.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,251.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,567.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,183.39
|
| Rate for Payer: Zelis Auto |
$1,369.20
|
|
|
IMPLT NAIL TROCHANTRIC GRIP LARGE
|
Facility
|
OP
|
$3,423.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.75 |
| Max. Negotiated Rate |
$3,251.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,053.80
|
| Rate for Payer: Cash Price |
$2,053.80
|
| Rate for Payer: Cash Price |
$2,053.80
|
| Rate for Payer: Cigna Commercial |
$2,909.55
|
| Rate for Payer: First Health Commercial |
$3,080.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,080.70
|
| Rate for Payer: GEHA Commercial |
$2,738.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,080.70
|
| Rate for Payer: Humana ChoiceCare |
$889.98
|
| Rate for Payer: Multiplan All |
$3,114.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,053.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,396.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,080.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,251.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,567.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,012.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$855.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,183.39
|
| Rate for Payer: Zelis Auto |
$1,369.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,711.50
|
|
|
IMPLT NAV HD 11/13FRX28CM
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.25 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$538.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Humana ChoiceCare |
$174.98
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$403.80
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$592.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.50
|
|
|
IMPLT NAV HD 11/13FRX28CM
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.40
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$471.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
|
|
IMPLT NAV HD 11/13FRX36CM
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7001666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.25 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$538.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Humana ChoiceCare |
$174.98
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$403.80
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$592.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.50
|
|
|
IMPLT NAV HD 11/13FRX36CM
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7001666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.40
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$471.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
|
|
IMPLT NAV HD 11/13FRX46CM
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.25 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$538.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Humana ChoiceCare |
$174.98
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$403.80
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$592.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.50
|
|
|
IMPLT NAV HD 11/13FRX46CM
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.40
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$471.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
|
|
IMPLT NAV HD 13/15FRX28CM
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.25 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$538.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Humana ChoiceCare |
$174.98
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$403.80
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$592.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.50
|
|
|
IMPLT NAV HD 13/15FRX28CM
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.40
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$471.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
|
|
IMPLT NAV HD 13/15FRX36CM
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.25 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$538.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Humana ChoiceCare |
$174.98
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$403.80
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$592.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.50
|
|
|
IMPLT NAV HD 13/15FRX36CM
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7001670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.40
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$471.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
|
|
IMPLT NAV HD 13/15FRX46CM
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7003273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.40
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$471.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
|
|
IMPLT NAV HD 13/15FRX46CM
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
7003273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.25 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$538.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Humana ChoiceCare |
$174.98
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$403.80
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$592.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.50
|
|
|
IMPLT NECK MODULAR 12/14 TAPER
|
Facility
|
IP
|
$4,981.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,992.40 |
| Max. Negotiated Rate |
$4,731.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,984.80
|
| Rate for Payer: Cash Price |
$2,988.60
|
| Rate for Payer: Cash Price |
$2,988.60
|
| Rate for Payer: Cigna Commercial |
$4,233.85
|
| Rate for Payer: First Health Commercial |
$4,482.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,482.90
|
| Rate for Payer: GEHA Commercial |
$3,486.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,482.90
|
| Rate for Payer: Multiplan All |
$4,532.71
|
| Rate for Payer: OMNI Networks Commercial |
$3,486.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,482.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,731.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,735.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,632.33
|
| Rate for Payer: Zelis Auto |
$1,992.40
|
|
|
IMPLT NECK MODULAR 12/14 TAPER
|
Facility
|
OP
|
$4,981.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,245.25 |
| Max. Negotiated Rate |
$4,731.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,988.60
|
| Rate for Payer: Cash Price |
$2,988.60
|
| Rate for Payer: Cash Price |
$2,988.60
|
| Rate for Payer: Cigna Commercial |
$4,233.85
|
| Rate for Payer: First Health Commercial |
$4,482.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,482.90
|
| Rate for Payer: GEHA Commercial |
$3,984.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,482.90
|
| Rate for Payer: Humana ChoiceCare |
$1,295.06
|
| Rate for Payer: Multiplan All |
$4,532.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,988.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,486.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,482.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,731.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,735.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,383.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,245.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,632.33
|
| Rate for Payer: Zelis Auto |
$1,992.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,490.50
|
|
