|
IMPLT SP FIBERTAK RC TIGER TAPE
|
Facility
|
IP
|
$2,130.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.00 |
| Max. Negotiated Rate |
$2,023.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,704.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$1,810.50
|
| Rate for Payer: First Health Commercial |
$1,917.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,917.00
|
| Rate for Payer: GEHA Commercial |
$1,491.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,917.00
|
| Rate for Payer: Multiplan All |
$1,938.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,491.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,917.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,023.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,597.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,980.90
|
| Rate for Payer: Zelis Auto |
$852.00
|
|
|
IMPLT SP FIBERTAK RC TIGER TAPE
|
Facility
|
OP
|
$2,130.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$2,023.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$1,810.50
|
| Rate for Payer: First Health Commercial |
$1,917.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,917.00
|
| Rate for Payer: GEHA Commercial |
$1,704.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,917.00
|
| Rate for Payer: Humana ChoiceCare |
$553.80
|
| Rate for Payer: Multiplan All |
$1,938.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,278.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,491.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,917.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,023.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,597.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,874.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$532.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,980.90
|
| Rate for Payer: Zelis Auto |
$852.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,065.00
|
|
|
IMPLT SP FIBERTAK RC TIGER TAPE
|
Facility
|
OP
|
$2,130.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$2,023.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$1,810.50
|
| Rate for Payer: First Health Commercial |
$1,917.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,917.00
|
| Rate for Payer: GEHA Commercial |
$1,704.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,917.00
|
| Rate for Payer: Humana ChoiceCare |
$553.80
|
| Rate for Payer: Multiplan All |
$1,938.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,278.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,491.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,917.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,023.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,597.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,874.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$532.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,980.90
|
| Rate for Payer: Zelis Auto |
$852.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,065.00
|
|
|
IMPLT SP FIBERTAK RC TIGER TAPE
|
Facility
|
IP
|
$2,130.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.00 |
| Max. Negotiated Rate |
$2,023.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,704.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$1,810.50
|
| Rate for Payer: First Health Commercial |
$1,917.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,917.00
|
| Rate for Payer: GEHA Commercial |
$1,491.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,917.00
|
| Rate for Payer: Multiplan All |
$1,938.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,491.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,917.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,023.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,597.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,980.90
|
| Rate for Payer: Zelis Auto |
$852.00
|
|
|
IMPLT SPRING PIN 5MX20MM 5DE56
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$32.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$34.00
|
| Rate for Payer: First Health Commercial |
$36.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.00
|
| Rate for Payer: GEHA Commercial |
$28.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.00
|
| Rate for Payer: Multiplan All |
$36.40
|
| Rate for Payer: OMNI Networks Commercial |
$28.00
|
| Rate for Payer: One Health Plan PPO/POS |
$36.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.00
|
| Rate for Payer: Three Rivers Provider Network All |
$30.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37.20
|
| Rate for Payer: Zelis Auto |
$16.00
|
|
|
IMPLT SPRING PIN 5MX20MM 5DE56
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$34.00
|
| Rate for Payer: First Health Commercial |
$36.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.00
|
| Rate for Payer: GEHA Commercial |
$32.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.00
|
| Rate for Payer: Humana ChoiceCare |
$10.40
|
| Rate for Payer: Multiplan All |
$36.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.00
|
| Rate for Payer: OMNI Networks Commercial |
$28.00
|
| Rate for Payer: One Health Plan PPO/POS |
$36.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.00
|
| Rate for Payer: Three Rivers Provider Network All |
$30.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$35.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$37.20
|
| Rate for Payer: Zelis Auto |
$16.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.00
|
|
|
IMPLT STABILIZED POSTERIOR FEMORAL #6
|
Facility
|
IP
|
$7,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,890.00 |
| Max. Negotiated Rate |
$6,863.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,780.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cigna Commercial |
$6,141.25
|
| Rate for Payer: First Health Commercial |
$6,502.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,502.50
|
| Rate for Payer: GEHA Commercial |
$5,057.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,502.50
|
| Rate for Payer: Multiplan All |
$6,574.75
|
| Rate for Payer: OMNI Networks Commercial |
$5,057.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,502.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,863.75
|
| Rate for Payer: Three Rivers Provider Network All |
$5,418.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,719.25
|
| Rate for Payer: Zelis Auto |
$2,890.00
|
|
|
IMPLT STABILIZED POSTERIOR FEMORAL #6
|
Facility
|
OP
|
$7,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,806.25 |
| Max. Negotiated Rate |
$6,863.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,335.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cigna Commercial |
$6,141.25
|
| Rate for Payer: First Health Commercial |
$6,502.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,502.50
|
| Rate for Payer: GEHA Commercial |
$5,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,502.50
|
| Rate for Payer: Humana ChoiceCare |
$1,878.50
|
| Rate for Payer: Multiplan All |
$6,574.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,335.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,057.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,502.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,863.75
|
| Rate for Payer: Three Rivers Provider Network All |
$5,418.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,358.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,806.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,719.25
|
| Rate for Payer: Zelis Auto |
$2,890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,612.50
|
|
|
IMPLT STABILIZER FEMORAL COMPOPNENT
|
Facility
|
OP
|
$19,195.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,798.75 |
| Max. Negotiated Rate |
$18,235.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11,517.00
|
| Rate for Payer: Cash Price |
$11,517.00
|
| Rate for Payer: Cash Price |
$11,517.00
|
| Rate for Payer: Cigna Commercial |
$16,315.75
|
| Rate for Payer: First Health Commercial |
$17,275.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17,275.50
|
| Rate for Payer: GEHA Commercial |
$15,356.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17,275.50
|
| Rate for Payer: Humana ChoiceCare |
$4,990.70
|
| Rate for Payer: Multiplan All |
$17,467.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,517.00
|
| Rate for Payer: OMNI Networks Commercial |
$13,436.50
|
| Rate for Payer: One Health Plan PPO/POS |
$17,275.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18,235.25
|
| Rate for Payer: Three Rivers Provider Network All |
$14,396.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,891.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,798.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17,851.35
|
| Rate for Payer: Zelis Auto |
$7,678.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,597.50
|
|
|
IMPLT STABILIZER FEMORAL COMPOPNENT
|
Facility
|
IP
|
$19,195.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,678.00 |
| Max. Negotiated Rate |
$18,235.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15,356.00
|
| Rate for Payer: Cash Price |
$11,517.00
|
| Rate for Payer: Cash Price |
$11,517.00
|
| Rate for Payer: Cigna Commercial |
$16,315.75
|
| Rate for Payer: First Health Commercial |
$17,275.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17,275.50
|
| Rate for Payer: GEHA Commercial |
$13,436.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17,275.50
|
| Rate for Payer: Multiplan All |
$17,467.45
|
| Rate for Payer: OMNI Networks Commercial |
$13,436.50
|
| Rate for Payer: One Health Plan PPO/POS |
$17,275.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18,235.25
|
| Rate for Payer: Three Rivers Provider Network All |
$14,396.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17,851.35
|
| Rate for Payer: Zelis Auto |
$7,678.00
|
|
|
IMPLT STA-FLEX GUIDE WIRE 9" #906853
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.75 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$288.15
|
| Rate for Payer: First Health Commercial |
$305.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$305.10
|
| Rate for Payer: GEHA Commercial |
$271.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$305.10
|
| Rate for Payer: Humana ChoiceCare |
$88.14
|
| Rate for Payer: Multiplan All |
$308.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$203.40
|
| Rate for Payer: OMNI Networks Commercial |
$237.30
|
| Rate for Payer: One Health Plan PPO/POS |
$305.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$322.05
|
| Rate for Payer: Three Rivers Provider Network All |
$254.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$298.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$315.27
|
| Rate for Payer: Zelis Auto |
$135.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$169.50
|
|
|
IMPLT STA-FLEX GUIDE WIRE 9" #906853
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$271.20
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$288.15
|
| Rate for Payer: First Health Commercial |
$305.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$305.10
|
| Rate for Payer: GEHA Commercial |
$237.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$305.10
|
| Rate for Payer: Multiplan All |
$308.49
|
| Rate for Payer: OMNI Networks Commercial |
$237.30
|
| Rate for Payer: One Health Plan PPO/POS |
$305.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$322.05
|
| Rate for Payer: Three Rivers Provider Network All |
$254.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$315.27
|
| Rate for Payer: Zelis Auto |
$135.60
|
|
|
IMPLT STA-FLEX SUBTALAR IMP #982365
|
Facility
|
OP
|
$3,870.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$967.50 |
| Max. Negotiated Rate |
$3,676.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,322.00
|
| Rate for Payer: Cash Price |
$2,322.00
|
| Rate for Payer: Cash Price |
$2,322.00
|
| Rate for Payer: Cigna Commercial |
$3,289.50
|
| Rate for Payer: First Health Commercial |
$3,483.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,483.00
|
| Rate for Payer: GEHA Commercial |
$3,096.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,483.00
|
| Rate for Payer: Humana ChoiceCare |
$1,006.20
|
| Rate for Payer: Multiplan All |
$3,521.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,322.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,709.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,483.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,676.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,902.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,405.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$967.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,599.10
|
| Rate for Payer: Zelis Auto |
$1,548.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,935.00
|
|
|
IMPLT STA-FLEX SUBTALAR IMP #982365
|
Facility
|
IP
|
$3,870.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.00 |
| Max. Negotiated Rate |
$3,676.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,096.00
|
| Rate for Payer: Cash Price |
$2,322.00
|
| Rate for Payer: Cash Price |
$2,322.00
|
| Rate for Payer: Cigna Commercial |
$3,289.50
|
| Rate for Payer: First Health Commercial |
$3,483.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,483.00
|
| Rate for Payer: GEHA Commercial |
$2,709.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,483.00
|
| Rate for Payer: Multiplan All |
$3,521.70
|
| Rate for Payer: OMNI Networks Commercial |
$2,709.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,483.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,676.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,902.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,599.10
|
| Rate for Payer: Zelis Auto |
$1,548.00
|
|
|
IMPLT STAPLE CLIP EASY 18X12X12MM
|
Facility
|
IP
|
$5,027.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.80 |
| Max. Negotiated Rate |
$4,775.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,021.60
|
| Rate for Payer: Cash Price |
$3,016.20
|
| Rate for Payer: Cash Price |
$3,016.20
|
| Rate for Payer: Cigna Commercial |
$4,272.95
|
| Rate for Payer: First Health Commercial |
$4,524.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,524.30
|
| Rate for Payer: GEHA Commercial |
$3,518.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,524.30
|
| Rate for Payer: Multiplan All |
$4,574.57
|
| Rate for Payer: OMNI Networks Commercial |
$3,518.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,524.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,775.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,770.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,675.11
|
| Rate for Payer: Zelis Auto |
$2,010.80
|
|
|
IMPLT STAPLE CLIP EASY 18X12X12MM
|
Facility
|
OP
|
$5,027.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,256.75 |
| Max. Negotiated Rate |
$4,775.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,016.20
|
| Rate for Payer: Cash Price |
$3,016.20
|
| Rate for Payer: Cash Price |
$3,016.20
|
| Rate for Payer: Cigna Commercial |
$4,272.95
|
| Rate for Payer: First Health Commercial |
$4,524.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,524.30
|
| Rate for Payer: GEHA Commercial |
$4,021.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,524.30
|
| Rate for Payer: Humana ChoiceCare |
$1,307.02
|
| Rate for Payer: Multiplan All |
$4,574.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,016.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,518.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,524.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,775.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,770.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,423.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,256.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,675.11
|
| Rate for Payer: Zelis Auto |
$2,010.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,513.50
|
|
|
IMPLT STAPLE EASYCLIP 15X12X12MM
|
Facility
|
IP
|
$4,276.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.40 |
| Max. Negotiated Rate |
$4,062.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,420.80
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cigna Commercial |
$3,634.60
|
| Rate for Payer: First Health Commercial |
$3,848.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,848.40
|
| Rate for Payer: GEHA Commercial |
$2,993.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,848.40
|
| Rate for Payer: Multiplan All |
$3,891.16
|
| Rate for Payer: OMNI Networks Commercial |
$2,993.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,848.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,062.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,207.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,976.68
|
| Rate for Payer: Zelis Auto |
$1,710.40
|
|
|
IMPLT STAPLE EASYCLIP 15X12X12MM
|
Facility
|
OP
|
$4,276.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$4,062.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,565.60
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cigna Commercial |
$3,634.60
|
| Rate for Payer: First Health Commercial |
$3,848.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,848.40
|
| Rate for Payer: GEHA Commercial |
$3,420.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,848.40
|
| Rate for Payer: Humana ChoiceCare |
$1,111.76
|
| Rate for Payer: Multiplan All |
$3,891.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,565.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,993.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,848.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,062.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,207.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,762.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,069.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,976.68
|
| Rate for Payer: Zelis Auto |
$1,710.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,138.00
|
|
|
IMPLT STAPLE EASYCLIP 15X15X15MM
|
Facility
|
IP
|
$4,669.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,867.60 |
| Max. Negotiated Rate |
$4,435.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,735.20
|
| Rate for Payer: Cash Price |
$2,801.40
|
| Rate for Payer: Cash Price |
$2,801.40
|
| Rate for Payer: Cigna Commercial |
$3,968.65
|
| Rate for Payer: First Health Commercial |
$4,202.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,202.10
|
| Rate for Payer: GEHA Commercial |
$3,268.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,202.10
|
| Rate for Payer: Multiplan All |
$4,248.79
|
| Rate for Payer: OMNI Networks Commercial |
$3,268.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,202.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,435.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,501.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,342.17
|
| Rate for Payer: Zelis Auto |
$1,867.60
|
|
|
IMPLT STAPLE EASYCLIP 15X15X15MM
|
Facility
|
OP
|
$4,669.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.25 |
| Max. Negotiated Rate |
$4,435.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,801.40
|
| Rate for Payer: Cash Price |
$2,801.40
|
| Rate for Payer: Cash Price |
$2,801.40
|
| Rate for Payer: Cigna Commercial |
$3,968.65
|
| Rate for Payer: First Health Commercial |
$4,202.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,202.10
|
| Rate for Payer: GEHA Commercial |
$3,735.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,202.10
|
| Rate for Payer: Humana ChoiceCare |
$1,213.94
|
| Rate for Payer: Multiplan All |
$4,248.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,801.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,268.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,202.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,435.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,501.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,108.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,167.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,342.17
|
| Rate for Payer: Zelis Auto |
$1,867.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.50
|
|
|
IMPLT STAPLE EASYCLIP 18X14X14MM
|
Facility
|
OP
|
$4,276.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$4,062.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,565.60
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cigna Commercial |
$3,634.60
|
| Rate for Payer: First Health Commercial |
$3,848.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,848.40
|
| Rate for Payer: GEHA Commercial |
$3,420.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,848.40
|
| Rate for Payer: Humana ChoiceCare |
$1,111.76
|
| Rate for Payer: Multiplan All |
$3,891.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,565.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,993.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,848.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,062.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,207.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,762.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,069.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,976.68
|
| Rate for Payer: Zelis Auto |
$1,710.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,138.00
|
|
|
IMPLT STAPLE EASYCLIP 18X14X14MM
|
Facility
|
IP
|
$4,276.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.40 |
| Max. Negotiated Rate |
$4,062.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,420.80
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cigna Commercial |
$3,634.60
|
| Rate for Payer: First Health Commercial |
$3,848.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,848.40
|
| Rate for Payer: GEHA Commercial |
$2,993.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,848.40
|
| Rate for Payer: Multiplan All |
$3,891.16
|
| Rate for Payer: OMNI Networks Commercial |
$2,993.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,848.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,062.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,207.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,976.68
|
| Rate for Payer: Zelis Auto |
$1,710.40
|
|
|
IMPLT STAPLER 29MM INTRALUM ECS29
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7007047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$658.40
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
|
|
IMPLT STAPLER 29MM INTRALUM ECS29
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7007047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.75 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Humana ChoiceCare |
$213.98
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$493.80
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$724.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$205.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$411.50
|
|
|
IMPLT STD PAT A SERIES 37 3 PEG
|
Facility
|
OP
|
$2,081.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.25 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,664.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Humana ChoiceCare |
$541.06
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,248.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,831.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,040.50
|
|
