|
IMPLT PIN STEINMANN 3/32
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$258.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Humana ChoiceCare |
$83.98
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$193.80
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$306.85
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$284.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$80.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$161.50
|
|
|
IMPLT PIN STEINMANN 3/32
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.40
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$226.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$306.85
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: Zelis Auto |
$129.20
|
|
|
IMPLT PIN STEINMANN 3/32 POINT TROCAR
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$56.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: First Health Commercial |
$63.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.00
|
| Rate for Payer: GEHA Commercial |
$49.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.00
|
| Rate for Payer: Multiplan All |
$63.70
|
| Rate for Payer: OMNI Networks Commercial |
$49.00
|
| Rate for Payer: One Health Plan PPO/POS |
$63.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$66.50
|
| Rate for Payer: Three Rivers Provider Network All |
$52.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$65.10
|
| Rate for Payer: Zelis Auto |
$28.00
|
|
|
IMPLT PIN STEINMANN 3/32 POINT TROCAR
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: First Health Commercial |
$63.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.00
|
| Rate for Payer: GEHA Commercial |
$56.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.00
|
| Rate for Payer: Humana ChoiceCare |
$18.20
|
| Rate for Payer: Multiplan All |
$63.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$42.00
|
| Rate for Payer: OMNI Networks Commercial |
$49.00
|
| Rate for Payer: One Health Plan PPO/POS |
$63.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$66.50
|
| Rate for Payer: Three Rivers Provider Network All |
$52.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$61.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$65.10
|
| Rate for Payer: Zelis Auto |
$28.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.00
|
|
|
IMPLT PIN STEINMANN 3/32 TROCAR POINT
|
Facility
|
OP
|
$1,456.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$1,383.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$873.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cigna Commercial |
$1,237.60
|
| Rate for Payer: First Health Commercial |
$1,310.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,310.40
|
| Rate for Payer: GEHA Commercial |
$1,164.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,310.40
|
| Rate for Payer: Humana ChoiceCare |
$378.56
|
| Rate for Payer: Multiplan All |
$1,324.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$873.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,019.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,310.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,383.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,092.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,281.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$364.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,354.08
|
| Rate for Payer: Zelis Auto |
$582.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$728.00
|
|
|
IMPLT PIN STEINMANN 3/32 TROCAR POINT
|
Facility
|
IP
|
$1,456.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.40 |
| Max. Negotiated Rate |
$1,383.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,164.80
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cigna Commercial |
$1,237.60
|
| Rate for Payer: First Health Commercial |
$1,310.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,310.40
|
| Rate for Payer: GEHA Commercial |
$1,019.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,310.40
|
| Rate for Payer: Multiplan All |
$1,324.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,019.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,310.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,383.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,092.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,354.08
|
| Rate for Payer: Zelis Auto |
$582.40
|
|
|
IMPLT PIN STEINMANN 4.5MM X 9INCH
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$198.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| Rate for Payer: Humana ChoiceCare |
$64.48
|
| Rate for Payer: Multiplan All |
$225.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$148.80
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$235.60
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$218.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$230.64
|
| Rate for Payer: Zelis Auto |
$99.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$124.00
|
|
|
IMPLT PIN STEINMANN 4.5MM X 9INCH
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$198.40
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| Rate for Payer: Multiplan All |
$225.68
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$235.60
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$230.64
|
| Rate for Payer: Zelis Auto |
$99.20
|
|
|
IMPLT PIN STEINMANN 5/32
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.75 |
| Max. Negotiated Rate |
$447.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$282.60
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cigna Commercial |
$400.35
|
| Rate for Payer: First Health Commercial |
$423.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.90
|
| Rate for Payer: GEHA Commercial |
$376.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.90
|
| Rate for Payer: Humana ChoiceCare |
$122.46
|
| Rate for Payer: Multiplan All |
$428.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$282.60
|
| Rate for Payer: OMNI Networks Commercial |
$329.70
|
| Rate for Payer: One Health Plan PPO/POS |
$423.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$447.45
|
| Rate for Payer: Three Rivers Provider Network All |
$353.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$414.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.03
|
| Rate for Payer: Zelis Auto |
$188.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$235.50
|
|
|
IMPLT PIN STEINMANN 5/32
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.40 |
| Max. Negotiated Rate |
$447.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$376.80
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cigna Commercial |
$400.35
|
| Rate for Payer: First Health Commercial |
$423.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.90
|
| Rate for Payer: GEHA Commercial |
$329.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.90
|
| Rate for Payer: Multiplan All |
$428.61
|
| Rate for Payer: OMNI Networks Commercial |
$329.70
|
| Rate for Payer: One Health Plan PPO/POS |
$423.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$447.45
|
| Rate for Payer: Three Rivers Provider Network All |
$353.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.03
|
| Rate for Payer: Zelis Auto |
$188.40
|
|
|
IMPLT PIN STEINMANN 5/32X23CM
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.25 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$365.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Humana ChoiceCare |
$118.82
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$274.20
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$402.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: Zelis Auto |
$182.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$228.50
|
|
|
IMPLT PIN STEINMANN 5/32X23CM
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.80 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$365.60
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$319.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: Zelis Auto |
$182.80
|
|
|
IMPLT PIN STEINMANN 5/64 TROCAR PT.
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Humana ChoiceCare |
$36.40
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$84.00
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$123.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$70.00
|
|
|
IMPLT PIN STEINMANN 5/64 TROCAR PT.
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$98.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: Zelis Auto |
$56.00
|
|
|
IMPLT PIN STEINMANN 7/64 DIAMOND PT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Humana ChoiceCare |
$36.40
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$84.00
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$123.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$70.00
|
|
|
IMPLT PIN STEINMANN 7/64 DIAMOND PT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$98.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: Zelis Auto |
$56.00
|
|
|
IMPLT PIN STEINMANN 7/64 TROCAR PT
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$71.40
|
| Rate for Payer: First Health Commercial |
$75.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$75.60
|
| Rate for Payer: GEHA Commercial |
$58.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$75.60
|
| Rate for Payer: Multiplan All |
$76.44
|
| Rate for Payer: OMNI Networks Commercial |
$58.80
|
| Rate for Payer: One Health Plan PPO/POS |
$75.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$79.80
|
| Rate for Payer: Three Rivers Provider Network All |
$63.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$78.12
|
| Rate for Payer: Zelis Auto |
$33.60
|
|
|
IMPLT PIN STEINMANN 7/64 TROCAR PT
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$71.40
|
| Rate for Payer: First Health Commercial |
$75.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$75.60
|
| Rate for Payer: GEHA Commercial |
$67.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$75.60
|
| Rate for Payer: Humana ChoiceCare |
$21.84
|
| Rate for Payer: Multiplan All |
$76.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$50.40
|
| Rate for Payer: OMNI Networks Commercial |
$58.80
|
| Rate for Payer: One Health Plan PPO/POS |
$75.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$79.80
|
| Rate for Payer: Three Rivers Provider Network All |
$63.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$73.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$78.12
|
| Rate for Payer: Zelis Auto |
$33.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.00
|
|
|
IMPLT PIN STEINMANN 9/64X23CM
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.80 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$365.60
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$319.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: Zelis Auto |
$182.80
|
|
|
IMPLT PIN STEINMANN 9/64X23CM
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.25 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$365.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Humana ChoiceCare |
$118.82
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$274.20
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$402.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: Zelis Auto |
$182.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$228.50
|
|
|
IMPLT PIN STEINMANN POINT DIAMOND 3/32
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$32.76
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$75.60
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$110.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$63.00
|
|
|
IMPLT PIN STEINMANN POINT DIAMOND 3/32
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
|
|
IMPLT PIN STEINMANN POINT DIAMOND 5/64
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$119.85
|
| Rate for Payer: First Health Commercial |
$126.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.90
|
| Rate for Payer: GEHA Commercial |
$112.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.90
|
| Rate for Payer: Humana ChoiceCare |
$36.66
|
| Rate for Payer: Multiplan All |
$128.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$84.60
|
| Rate for Payer: OMNI Networks Commercial |
$98.70
|
| Rate for Payer: One Health Plan PPO/POS |
$126.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.95
|
| Rate for Payer: Three Rivers Provider Network All |
$105.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$124.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$131.13
|
| Rate for Payer: Zelis Auto |
$56.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$70.50
|
|
|
IMPLT PIN STEINMANN POINT DIAMOND 5/64
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.80
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$119.85
|
| Rate for Payer: First Health Commercial |
$126.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.90
|
| Rate for Payer: GEHA Commercial |
$98.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.90
|
| Rate for Payer: Multiplan All |
$128.31
|
| Rate for Payer: OMNI Networks Commercial |
$98.70
|
| Rate for Payer: One Health Plan PPO/POS |
$126.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.95
|
| Rate for Payer: Three Rivers Provider Network All |
$105.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$131.13
|
| Rate for Payer: Zelis Auto |
$56.40
|
|
|
IMPLT PIN STEINMANN POINT DIAMOND 7/64
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$107.20
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
|
