|
IMPLT PEG THREADED 4.0X35MM
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$553.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$495.55
|
| Rate for Payer: First Health Commercial |
$524.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$524.70
|
| Rate for Payer: GEHA Commercial |
$466.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$524.70
|
| Rate for Payer: Humana ChoiceCare |
$151.58
|
| Rate for Payer: Multiplan All |
$530.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$349.80
|
| Rate for Payer: OMNI Networks Commercial |
$408.10
|
| Rate for Payer: One Health Plan PPO/POS |
$524.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$553.85
|
| Rate for Payer: Three Rivers Provider Network All |
$437.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$513.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$145.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$542.19
|
| Rate for Payer: Zelis Auto |
$233.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$291.50
|
|
|
IMPLT PEG THREADED 4.0X35MM
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.20 |
| Max. Negotiated Rate |
$553.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$466.40
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$495.55
|
| Rate for Payer: First Health Commercial |
$524.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$524.70
|
| Rate for Payer: GEHA Commercial |
$408.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$524.70
|
| Rate for Payer: Multiplan All |
$530.53
|
| Rate for Payer: OMNI Networks Commercial |
$408.10
|
| Rate for Payer: One Health Plan PPO/POS |
$524.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$553.85
|
| Rate for Payer: Three Rivers Provider Network All |
$437.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$542.19
|
| Rate for Payer: Zelis Auto |
$233.20
|
|
|
IMPLT PEG THREADED 4.0X45MM
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$481.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.60
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cigna Commercial |
$430.95
|
| Rate for Payer: First Health Commercial |
$456.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$456.30
|
| Rate for Payer: GEHA Commercial |
$354.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$456.30
|
| Rate for Payer: Multiplan All |
$461.37
|
| Rate for Payer: OMNI Networks Commercial |
$354.90
|
| Rate for Payer: One Health Plan PPO/POS |
$456.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$481.65
|
| Rate for Payer: Three Rivers Provider Network All |
$380.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$471.51
|
| Rate for Payer: Zelis Auto |
$202.80
|
|
|
IMPLT PEG THREADED 4.0X45MM
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$481.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.20
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cigna Commercial |
$430.95
|
| Rate for Payer: First Health Commercial |
$456.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$456.30
|
| Rate for Payer: GEHA Commercial |
$405.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$456.30
|
| Rate for Payer: Humana ChoiceCare |
$131.82
|
| Rate for Payer: Multiplan All |
$461.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$304.20
|
| Rate for Payer: OMNI Networks Commercial |
$354.90
|
| Rate for Payer: One Health Plan PPO/POS |
$456.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$481.65
|
| Rate for Payer: Three Rivers Provider Network All |
$380.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$446.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$126.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$471.51
|
| Rate for Payer: Zelis Auto |
$202.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$253.50
|
|
|
IMPLT PEG THREADED 4.0X50MM
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$553.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$495.55
|
| Rate for Payer: First Health Commercial |
$524.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$524.70
|
| Rate for Payer: GEHA Commercial |
$466.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$524.70
|
| Rate for Payer: Humana ChoiceCare |
$151.58
|
| Rate for Payer: Multiplan All |
$530.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$349.80
|
| Rate for Payer: OMNI Networks Commercial |
$408.10
|
| Rate for Payer: One Health Plan PPO/POS |
$524.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$553.85
|
| Rate for Payer: Three Rivers Provider Network All |
$437.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$513.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$145.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$542.19
|
| Rate for Payer: Zelis Auto |
$233.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$291.50
|
|
|
IMPLT PEG THREADED 4.0X50MM
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.20 |
| Max. Negotiated Rate |
$553.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$466.40
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$495.55
|
| Rate for Payer: First Health Commercial |
$524.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$524.70
|
| Rate for Payer: GEHA Commercial |
$408.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$524.70
|
| Rate for Payer: Multiplan All |
$530.53
|
| Rate for Payer: OMNI Networks Commercial |
$408.10
|
| Rate for Payer: One Health Plan PPO/POS |
$524.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$553.85
|
| Rate for Payer: Three Rivers Provider Network All |
$437.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$542.19
|
| Rate for Payer: Zelis Auto |
$233.20
|
|
|
IMPLT PEG ULNAR SHORTENING REDUCTION
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$532.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$465.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| Rate for Payer: Multiplan All |
$605.15
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$631.75
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$618.45
|
| Rate for Payer: Zelis Auto |
$266.00
|
|
|
IMPLT PEG ULNAR SHORTENING REDUCTION
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.25 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$532.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| Rate for Payer: Humana ChoiceCare |
$172.90
|
| Rate for Payer: Multiplan All |
$605.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$399.00
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$631.75
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$585.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$166.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$618.45
|
| Rate for Payer: Zelis Auto |
$266.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$332.50
|
|
|
IMPLT PENL AMS 700 CX MS PUMP IZ
|
Facility
|
OP
|
$27,028.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7003053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,757.00 |
| Max. Negotiated Rate |
$25,676.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16,216.80
|
| Rate for Payer: Cash Price |
$16,216.80
|
| Rate for Payer: Cash Price |
$16,216.80
|
| Rate for Payer: Cigna Commercial |
$22,973.80
|
| Rate for Payer: First Health Commercial |
$24,325.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24,325.20
|
| Rate for Payer: GEHA Commercial |
$21,622.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24,325.20
|
| Rate for Payer: Humana ChoiceCare |
$7,027.28
|
| Rate for Payer: Multiplan All |
$24,595.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,216.80
|
| Rate for Payer: OMNI Networks Commercial |
$18,919.60
|
| Rate for Payer: One Health Plan PPO/POS |
$24,325.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$25,676.60
|
| Rate for Payer: Three Rivers Provider Network All |
$20,271.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23,784.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,757.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25,136.04
|
| Rate for Payer: Zelis Auto |
$10,811.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13,514.00
|
|
|
IMPLT PENL AMS 700 CX MS PUMP IZ
|
Facility
|
IP
|
$27,028.00
|
|
|
Service Code
|
CPT C1813
|
| Hospital Charge Code |
7003053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,811.20 |
| Max. Negotiated Rate |
$25,676.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21,622.40
|
| Rate for Payer: Cash Price |
$16,216.80
|
| Rate for Payer: Cash Price |
$16,216.80
|
| Rate for Payer: Cigna Commercial |
$22,973.80
|
| Rate for Payer: First Health Commercial |
$24,325.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$24,325.20
|
| Rate for Payer: GEHA Commercial |
$18,919.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$24,325.20
|
| Rate for Payer: Multiplan All |
$24,595.48
|
| Rate for Payer: OMNI Networks Commercial |
$18,919.60
|
| Rate for Payer: One Health Plan PPO/POS |
$24,325.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$25,676.60
|
| Rate for Payer: Three Rivers Provider Network All |
$20,271.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$25,136.04
|
| Rate for Payer: Zelis Auto |
$10,811.20
|
|
|
IMPLT PERI-LOC VLP 15MM SPIKED WASHR
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.25 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$483.65
|
| Rate for Payer: First Health Commercial |
$512.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$512.10
|
| Rate for Payer: GEHA Commercial |
$455.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Humana ChoiceCare |
$147.94
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$341.40
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: Zelis Auto |
$227.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$284.50
|
|
|
IMPLT PERI-LOC VLP 15MM SPIKED WASHR
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.60 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$455.20
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$483.65
|
| Rate for Payer: First Health Commercial |
$512.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$512.10
|
| Rate for Payer: GEHA Commercial |
$398.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: Zelis Auto |
$227.60
|
|
|
IMPLT PERI-LOC VLP 25MM SPIKED WASHR
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.25 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$483.65
|
| Rate for Payer: First Health Commercial |
$512.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$512.10
|
| Rate for Payer: GEHA Commercial |
$455.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Humana ChoiceCare |
$147.94
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$341.40
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: Zelis Auto |
$227.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$284.50
|
|
|
IMPLT PERI-LOC VLP 25MM SPIKED WASHR
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.60 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$455.20
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$483.65
|
| Rate for Payer: First Health Commercial |
$512.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$512.10
|
| Rate for Payer: GEHA Commercial |
$398.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: Zelis Auto |
$227.60
|
|
|
IMPLT PERI-LOC VLP BALL SPIKE
|
Facility
|
OP
|
$3,629.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.25 |
| Max. Negotiated Rate |
$3,447.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,177.40
|
| Rate for Payer: Cash Price |
$2,177.40
|
| Rate for Payer: Cash Price |
$2,177.40
|
| Rate for Payer: Cigna Commercial |
$3,084.65
|
| Rate for Payer: First Health Commercial |
$3,266.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,266.10
|
| Rate for Payer: GEHA Commercial |
$2,903.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,266.10
|
| Rate for Payer: Humana ChoiceCare |
$943.54
|
| Rate for Payer: Multiplan All |
$3,302.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,177.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,540.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,266.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,447.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,721.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,193.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$907.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,374.97
|
| Rate for Payer: Zelis Auto |
$1,451.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,814.50
|
|
|
IMPLT PERI-LOC VLP BALL SPIKE
|
Facility
|
IP
|
$3,629.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.60 |
| Max. Negotiated Rate |
$3,447.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,903.20
|
| Rate for Payer: Cash Price |
$2,177.40
|
| Rate for Payer: Cash Price |
$2,177.40
|
| Rate for Payer: Cigna Commercial |
$3,084.65
|
| Rate for Payer: First Health Commercial |
$3,266.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,266.10
|
| Rate for Payer: GEHA Commercial |
$2,540.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,266.10
|
| Rate for Payer: Multiplan All |
$3,302.39
|
| Rate for Payer: OMNI Networks Commercial |
$2,540.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,266.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,447.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,721.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,374.97
|
| Rate for Payer: Zelis Auto |
$1,451.60
|
|
|
IMPLT PERI-LOC VLP BALL SPIKE PUSHR
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.75 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$750.55
|
| Rate for Payer: First Health Commercial |
$794.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$794.70
|
| Rate for Payer: GEHA Commercial |
$706.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$794.70
|
| Rate for Payer: Humana ChoiceCare |
$229.58
|
| Rate for Payer: Multiplan All |
$803.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$529.80
|
| Rate for Payer: OMNI Networks Commercial |
$618.10
|
| Rate for Payer: One Health Plan PPO/POS |
$794.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$838.85
|
| Rate for Payer: Three Rivers Provider Network All |
$662.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$777.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$821.19
|
| Rate for Payer: Zelis Auto |
$353.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$441.50
|
|
|
IMPLT PERI-LOC VLP BALL SPIKE PUSHR
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.20 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$706.40
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$750.55
|
| Rate for Payer: First Health Commercial |
$794.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$794.70
|
| Rate for Payer: GEHA Commercial |
$618.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$794.70
|
| Rate for Payer: Multiplan All |
$803.53
|
| Rate for Payer: OMNI Networks Commercial |
$618.10
|
| Rate for Payer: One Health Plan PPO/POS |
$794.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$838.85
|
| Rate for Payer: Three Rivers Provider Network All |
$662.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$821.19
|
| Rate for Payer: Zelis Auto |
$353.20
|
|
|
IMPLT PERI-LOC VLP BALL SPIKE RDCTN
|
Facility
|
IP
|
$3,786.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,514.40 |
| Max. Negotiated Rate |
$3,596.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,028.80
|
| Rate for Payer: Cash Price |
$2,271.60
|
| Rate for Payer: Cash Price |
$2,271.60
|
| Rate for Payer: Cigna Commercial |
$3,218.10
|
| Rate for Payer: First Health Commercial |
$3,407.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,407.40
|
| Rate for Payer: GEHA Commercial |
$2,650.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,407.40
|
| Rate for Payer: Multiplan All |
$3,445.26
|
| Rate for Payer: OMNI Networks Commercial |
$2,650.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,407.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,596.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,839.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,520.98
|
| Rate for Payer: Zelis Auto |
$1,514.40
|
|
|
IMPLT PERI-LOC VLP BALL SPIKE RDCTN
|
Facility
|
OP
|
$3,786.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.50 |
| Max. Negotiated Rate |
$3,596.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,271.60
|
| Rate for Payer: Cash Price |
$2,271.60
|
| Rate for Payer: Cash Price |
$2,271.60
|
| Rate for Payer: Cigna Commercial |
$3,218.10
|
| Rate for Payer: First Health Commercial |
$3,407.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,407.40
|
| Rate for Payer: GEHA Commercial |
$3,028.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,407.40
|
| Rate for Payer: Humana ChoiceCare |
$984.36
|
| Rate for Payer: Multiplan All |
$3,445.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,271.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,650.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,407.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,596.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,839.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,331.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$946.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,520.98
|
| Rate for Payer: Zelis Auto |
$1,514.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,893.00
|
|
|
IMPLT PER K FEM/CEM TIB/VE SURF/VE PAT
|
Facility
|
IP
|
$15,834.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,333.60 |
| Max. Negotiated Rate |
$15,042.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,667.20
|
| Rate for Payer: Cash Price |
$9,500.40
|
| Rate for Payer: Cash Price |
$9,500.40
|
| Rate for Payer: Cigna Commercial |
$13,458.90
|
| Rate for Payer: First Health Commercial |
$14,250.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,250.60
|
| Rate for Payer: GEHA Commercial |
$11,083.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,250.60
|
| Rate for Payer: Multiplan All |
$14,408.94
|
| Rate for Payer: OMNI Networks Commercial |
$11,083.80
|
| Rate for Payer: One Health Plan PPO/POS |
$14,250.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,042.30
|
| Rate for Payer: Three Rivers Provider Network All |
$11,875.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,725.62
|
| Rate for Payer: Zelis Auto |
$6,333.60
|
|
|
IMPLT PER K FEM/CEM TIB/VE SURF/VE PAT
|
Facility
|
OP
|
$15,834.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,958.50 |
| Max. Negotiated Rate |
$15,042.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,500.40
|
| Rate for Payer: Cash Price |
$9,500.40
|
| Rate for Payer: Cash Price |
$9,500.40
|
| Rate for Payer: Cigna Commercial |
$13,458.90
|
| Rate for Payer: First Health Commercial |
$14,250.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,250.60
|
| Rate for Payer: GEHA Commercial |
$12,667.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,250.60
|
| Rate for Payer: Humana ChoiceCare |
$4,116.84
|
| Rate for Payer: Multiplan All |
$14,408.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,500.40
|
| Rate for Payer: OMNI Networks Commercial |
$11,083.80
|
| Rate for Payer: One Health Plan PPO/POS |
$14,250.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,042.30
|
| Rate for Payer: Three Rivers Provider Network All |
$11,875.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13,933.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,958.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,725.62
|
| Rate for Payer: Zelis Auto |
$6,333.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,917.00
|
|
|
IMPLT PERMANENT PACKAGE
|
Facility
|
IP
|
$40,438.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
7009050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16,175.20 |
| Max. Negotiated Rate |
$38,416.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$32,350.40
|
| Rate for Payer: Cash Price |
$24,262.80
|
| Rate for Payer: Cash Price |
$24,262.80
|
| Rate for Payer: Cigna Commercial |
$34,372.30
|
| Rate for Payer: First Health Commercial |
$36,394.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36,394.20
|
| Rate for Payer: GEHA Commercial |
$28,306.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36,394.20
|
| Rate for Payer: Multiplan All |
$36,798.58
|
| Rate for Payer: OMNI Networks Commercial |
$28,306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$36,394.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38,416.10
|
| Rate for Payer: Three Rivers Provider Network All |
$30,328.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37,607.34
|
| Rate for Payer: Zelis Auto |
$16,175.20
|
|
|
IMPLT PERMANENT PACKAGE
|
Facility
|
OP
|
$40,438.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
7009050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,109.50 |
| Max. Negotiated Rate |
$38,416.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24,262.80
|
| Rate for Payer: Cash Price |
$24,262.80
|
| Rate for Payer: Cash Price |
$24,262.80
|
| Rate for Payer: Cigna Commercial |
$34,372.30
|
| Rate for Payer: First Health Commercial |
$36,394.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36,394.20
|
| Rate for Payer: GEHA Commercial |
$32,350.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36,394.20
|
| Rate for Payer: Humana ChoiceCare |
$10,513.88
|
| Rate for Payer: Multiplan All |
$36,798.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24,262.80
|
| Rate for Payer: OMNI Networks Commercial |
$28,306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$36,394.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38,416.10
|
| Rate for Payer: Three Rivers Provider Network All |
$30,328.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$35,585.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10,109.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37,607.34
|
| Rate for Payer: Zelis Auto |
$16,175.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,219.00
|
|
|
IMPLT PHALANGEAL ANATOEMIC 23MM
|
Facility
|
OP
|
$3,785.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.25 |
| Max. Negotiated Rate |
$3,595.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,271.00
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cigna Commercial |
$3,217.25
|
| Rate for Payer: First Health Commercial |
$3,406.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,406.50
|
| Rate for Payer: GEHA Commercial |
$3,028.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,406.50
|
| Rate for Payer: Humana ChoiceCare |
$984.10
|
| Rate for Payer: Multiplan All |
$3,444.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,271.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,649.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,406.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,595.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,838.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,330.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$946.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,520.05
|
| Rate for Payer: Zelis Auto |
$1,514.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,892.50
|
|
