|
IMPLT TISSUE GRAFTJACKET 4X8CM
|
Facility
|
IP
|
$9,982.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
7002462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,992.80 |
| Max. Negotiated Rate |
$9,482.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,985.60
|
| Rate for Payer: Cash Price |
$5,989.20
|
| Rate for Payer: Cash Price |
$5,989.20
|
| Rate for Payer: Cigna Commercial |
$8,484.70
|
| Rate for Payer: First Health Commercial |
$8,983.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,983.80
|
| Rate for Payer: GEHA Commercial |
$6,987.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,983.80
|
| Rate for Payer: Multiplan All |
$9,083.62
|
| Rate for Payer: OMNI Networks Commercial |
$6,987.40
|
| Rate for Payer: One Health Plan PPO/POS |
$8,983.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,482.90
|
| Rate for Payer: Three Rivers Provider Network All |
$7,486.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,283.26
|
| Rate for Payer: Zelis Auto |
$3,992.80
|
|
|
IMPLT TOE ANATOEMIC 21.5MM
|
Facility
|
IP
|
$3,785.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,514.00 |
| Max. Negotiated Rate |
$3,595.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,028.00
|
| 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 |
$2,649.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,406.50
|
| Rate for Payer: Multiplan All |
$3,444.35
|
| 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: United Payors & United Providers UP&UP |
$3,520.05
|
| Rate for Payer: Zelis Auto |
$1,514.00
|
|
|
IMPLT TOE ANATOEMIC 21.5MM
|
Facility
|
OP
|
$3,785.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006120
|
|
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
|
|
|
IMPLT TOE FLEXIBLE W/GROM SZ 0
|
Facility
|
OP
|
$5,122.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.50 |
| Max. Negotiated Rate |
$4,865.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,073.20
|
| Rate for Payer: Cash Price |
$3,073.20
|
| Rate for Payer: Cash Price |
$3,073.20
|
| Rate for Payer: Cigna Commercial |
$4,353.70
|
| Rate for Payer: First Health Commercial |
$4,609.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,609.80
|
| Rate for Payer: GEHA Commercial |
$4,097.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,609.80
|
| Rate for Payer: Humana ChoiceCare |
$1,331.72
|
| Rate for Payer: Multiplan All |
$4,661.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,073.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,585.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,609.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,865.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,841.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,507.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,280.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,763.46
|
| Rate for Payer: Zelis Auto |
$2,048.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,561.00
|
|
|
IMPLT TOE FLEXIBLE W/GROM SZ 0
|
Facility
|
IP
|
$5,122.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,048.80 |
| Max. Negotiated Rate |
$4,865.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,097.60
|
| Rate for Payer: Cash Price |
$3,073.20
|
| Rate for Payer: Cash Price |
$3,073.20
|
| Rate for Payer: Cigna Commercial |
$4,353.70
|
| Rate for Payer: First Health Commercial |
$4,609.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,609.80
|
| Rate for Payer: GEHA Commercial |
$3,585.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,609.80
|
| Rate for Payer: Multiplan All |
$4,661.02
|
| Rate for Payer: OMNI Networks Commercial |
$3,585.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,609.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,865.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,841.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,763.46
|
| Rate for Payer: Zelis Auto |
$2,048.80
|
|
|
IMPLT TOE HINGE FLEXIBLE
|
Facility
|
OP
|
$3,538.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.50 |
| Max. Negotiated Rate |
$3,361.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,122.80
|
| Rate for Payer: Cash Price |
$2,122.80
|
| Rate for Payer: Cash Price |
$2,122.80
|
| Rate for Payer: Cigna Commercial |
$3,007.30
|
| Rate for Payer: First Health Commercial |
$3,184.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,184.20
|
| Rate for Payer: GEHA Commercial |
$2,830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,184.20
|
| Rate for Payer: Humana ChoiceCare |
$919.88
|
| Rate for Payer: Multiplan All |
$3,219.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,122.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,476.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,184.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,361.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,653.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,113.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$884.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,290.34
|
| Rate for Payer: Zelis Auto |
$1,415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,769.00
|
|
|
IMPLT TOE HINGE FLEXIBLE
|
Facility
|
IP
|
$3,538.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.20 |
| Max. Negotiated Rate |
$3,361.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,830.40
|
| Rate for Payer: Cash Price |
$2,122.80
|
| Rate for Payer: Cash Price |
$2,122.80
|
| Rate for Payer: Cigna Commercial |
$3,007.30
|
| Rate for Payer: First Health Commercial |
$3,184.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,184.20
|
| Rate for Payer: GEHA Commercial |
$2,476.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,184.20
|
| Rate for Payer: Multiplan All |
$3,219.58
|
| Rate for Payer: OMNI Networks Commercial |
$2,476.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,184.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,361.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,653.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,290.34
|
| Rate for Payer: Zelis Auto |
$1,415.20
|
|
|
IMPLT TOE HINGE FLEXIBLE SIZE 0 SHORT
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$363.25 |
| Max. Negotiated Rate |
$1,380.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$871.80
|
| Rate for Payer: Cash Price |
$871.80
|
| Rate for Payer: Cash Price |
$871.80
|
| Rate for Payer: Cigna Commercial |
$1,235.05
|
| Rate for Payer: First Health Commercial |
$1,307.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,307.70
|
| Rate for Payer: GEHA Commercial |
$1,162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,307.70
|
| Rate for Payer: Humana ChoiceCare |
$377.78
|
| Rate for Payer: Multiplan All |
$1,322.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$871.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,017.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,307.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,380.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,089.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,278.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$363.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,351.29
|
| Rate for Payer: Zelis Auto |
$581.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$726.50
|
|
|
IMPLT TOE HINGE FLEXIBLE SIZE 0 SHORT
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.20 |
| Max. Negotiated Rate |
$1,380.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,162.40
|
| Rate for Payer: Cash Price |
$871.80
|
| Rate for Payer: Cash Price |
$871.80
|
| Rate for Payer: Cigna Commercial |
$1,235.05
|
| Rate for Payer: First Health Commercial |
$1,307.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,307.70
|
| Rate for Payer: GEHA Commercial |
$1,017.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,307.70
|
| Rate for Payer: Multiplan All |
$1,322.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,017.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,307.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,380.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,089.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,351.29
|
| Rate for Payer: Zelis Auto |
$581.20
|
|
|
IMPLT TOE HINGE FLEXIBLE SIZE 3S
|
Facility
|
OP
|
$5,253.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,313.25 |
| Max. Negotiated Rate |
$4,990.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,151.80
|
| Rate for Payer: Cash Price |
$3,151.80
|
| Rate for Payer: Cash Price |
$3,151.80
|
| Rate for Payer: Cigna Commercial |
$4,465.05
|
| Rate for Payer: First Health Commercial |
$4,727.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,727.70
|
| Rate for Payer: GEHA Commercial |
$4,202.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,727.70
|
| Rate for Payer: Humana ChoiceCare |
$1,365.78
|
| Rate for Payer: Multiplan All |
$4,780.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,151.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,677.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,727.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,990.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,939.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,622.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,313.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,885.29
|
| Rate for Payer: Zelis Auto |
$2,101.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,626.50
|
|
|
IMPLT TOE HINGE FLEXIBLE SIZE 3S
|
Facility
|
IP
|
$5,253.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.20 |
| Max. Negotiated Rate |
$4,990.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,202.40
|
| Rate for Payer: Cash Price |
$3,151.80
|
| Rate for Payer: Cash Price |
$3,151.80
|
| Rate for Payer: Cigna Commercial |
$4,465.05
|
| Rate for Payer: First Health Commercial |
$4,727.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,727.70
|
| Rate for Payer: GEHA Commercial |
$3,677.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,727.70
|
| Rate for Payer: Multiplan All |
$4,780.23
|
| Rate for Payer: OMNI Networks Commercial |
$3,677.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,727.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,990.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,939.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,885.29
|
| Rate for Payer: Zelis Auto |
$2,101.20
|
|
|
IMPLT TOE HINGE FLEXIBLE SWANSON SIZE 1
|
Facility
|
IP
|
$4,745.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,898.00 |
| Max. Negotiated Rate |
$4,507.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,796.00
|
| Rate for Payer: Cash Price |
$2,847.00
|
| Rate for Payer: Cash Price |
$2,847.00
|
| Rate for Payer: Cigna Commercial |
$4,033.25
|
| Rate for Payer: First Health Commercial |
$4,270.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,270.50
|
| Rate for Payer: GEHA Commercial |
$3,321.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,270.50
|
| Rate for Payer: Multiplan All |
$4,317.95
|
| Rate for Payer: OMNI Networks Commercial |
$3,321.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,270.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,507.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,558.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,412.85
|
| Rate for Payer: Zelis Auto |
$1,898.00
|
|
|
IMPLT TOE HINGE FLEXIBLE SWANSON SIZE 1
|
Facility
|
OP
|
$4,745.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,186.25 |
| Max. Negotiated Rate |
$4,507.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,847.00
|
| Rate for Payer: Cash Price |
$2,847.00
|
| Rate for Payer: Cash Price |
$2,847.00
|
| Rate for Payer: Cigna Commercial |
$4,033.25
|
| Rate for Payer: First Health Commercial |
$4,270.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,270.50
|
| Rate for Payer: GEHA Commercial |
$3,796.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,270.50
|
| Rate for Payer: Humana ChoiceCare |
$1,233.70
|
| Rate for Payer: Multiplan All |
$4,317.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,847.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,321.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,270.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,507.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,558.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,175.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,186.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,412.85
|
| Rate for Payer: Zelis Auto |
$1,898.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,372.50
|
|
|
IMPLT TOE SILASTIC #3
|
Facility
|
OP
|
$5,461.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.25 |
| Max. Negotiated Rate |
$5,187.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,276.60
|
| Rate for Payer: Cash Price |
$3,276.60
|
| Rate for Payer: Cash Price |
$3,276.60
|
| Rate for Payer: Cigna Commercial |
$4,641.85
|
| Rate for Payer: First Health Commercial |
$4,914.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,914.90
|
| Rate for Payer: GEHA Commercial |
$4,368.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,914.90
|
| Rate for Payer: Humana ChoiceCare |
$1,419.86
|
| Rate for Payer: Multiplan All |
$4,969.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,276.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,822.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,914.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,187.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,095.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,805.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,365.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,078.73
|
| Rate for Payer: Zelis Auto |
$2,184.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,730.50
|
|
|
IMPLT TOE SILASTIC #3
|
Facility
|
IP
|
$5,461.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.40 |
| Max. Negotiated Rate |
$5,187.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,368.80
|
| Rate for Payer: Cash Price |
$3,276.60
|
| Rate for Payer: Cash Price |
$3,276.60
|
| Rate for Payer: Cigna Commercial |
$4,641.85
|
| Rate for Payer: First Health Commercial |
$4,914.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,914.90
|
| Rate for Payer: GEHA Commercial |
$3,822.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,914.90
|
| Rate for Payer: Multiplan All |
$4,969.51
|
| Rate for Payer: OMNI Networks Commercial |
$3,822.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,914.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,187.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,095.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,078.73
|
| Rate for Payer: Zelis Auto |
$2,184.40
|
|
|
IMPLT TRANSPROSTATIC CARTRIDGE
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
7006459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,140.00 |
| Max. Negotiated Rate |
$5,082.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,280.00
|
| Rate for Payer: Cash Price |
$3,210.00
|
| Rate for Payer: Cash Price |
$3,210.00
|
| Rate for Payer: Cigna Commercial |
$4,547.50
|
| Rate for Payer: First Health Commercial |
$4,815.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,815.00
|
| Rate for Payer: GEHA Commercial |
$3,745.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,815.00
|
| Rate for Payer: Multiplan All |
$4,868.50
|
| Rate for Payer: OMNI Networks Commercial |
$3,745.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,815.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,082.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,012.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,975.50
|
| Rate for Payer: Zelis Auto |
$2,140.00
|
|
|
IMPLT TRANSPROSTATIC CARTRIDGE
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
7006459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,337.50 |
| Max. Negotiated Rate |
$5,082.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,210.00
|
| Rate for Payer: Cash Price |
$3,210.00
|
| Rate for Payer: Cash Price |
$3,210.00
|
| Rate for Payer: Cigna Commercial |
$4,547.50
|
| Rate for Payer: First Health Commercial |
$4,815.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,815.00
|
| Rate for Payer: GEHA Commercial |
$4,280.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,815.00
|
| Rate for Payer: Humana ChoiceCare |
$1,391.00
|
| Rate for Payer: Multiplan All |
$4,868.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,210.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,745.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,815.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,082.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,012.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,708.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,337.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,975.50
|
| Rate for Payer: Zelis Auto |
$2,140.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,675.00
|
|
|
IMPLT TRANSPROSTATIC CYSTOURETHROSCOPY
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
7006381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,337.50 |
| Max. Negotiated Rate |
$5,082.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,210.00
|
| Rate for Payer: Cash Price |
$3,210.00
|
| Rate for Payer: Cash Price |
$3,210.00
|
| Rate for Payer: Cigna Commercial |
$4,547.50
|
| Rate for Payer: First Health Commercial |
$4,815.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,815.00
|
| Rate for Payer: GEHA Commercial |
$4,280.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,815.00
|
| Rate for Payer: Humana ChoiceCare |
$1,391.00
|
| Rate for Payer: Multiplan All |
$4,868.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,210.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,745.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,815.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,082.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,012.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,708.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,337.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,975.50
|
| Rate for Payer: Zelis Auto |
$2,140.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,675.00
|
|
|
IMPLT TRANSPROSTATIC CYSTOURETHROSCOPY
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
7006381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,140.00 |
| Max. Negotiated Rate |
$5,082.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,280.00
|
| Rate for Payer: Cash Price |
$3,210.00
|
| Rate for Payer: Cash Price |
$3,210.00
|
| Rate for Payer: Cigna Commercial |
$4,547.50
|
| Rate for Payer: First Health Commercial |
$4,815.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,815.00
|
| Rate for Payer: GEHA Commercial |
$3,745.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,815.00
|
| Rate for Payer: Multiplan All |
$4,868.50
|
| Rate for Payer: OMNI Networks Commercial |
$3,745.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,815.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,082.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,012.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,975.50
|
| Rate for Payer: Zelis Auto |
$2,140.00
|
|
|
IMPLT TRAY CATH POWER PICC 5FR
|
Facility
|
IP
|
$1,998.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
7001686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$799.20 |
| Max. Negotiated Rate |
$1,898.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,598.40
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cigna Commercial |
$1,698.30
|
| Rate for Payer: First Health Commercial |
$1,798.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,798.20
|
| Rate for Payer: GEHA Commercial |
$1,398.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,798.20
|
| Rate for Payer: Multiplan All |
$1,818.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,398.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,798.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,898.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,498.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,858.14
|
| Rate for Payer: Zelis Auto |
$799.20
|
|
|
IMPLT TRAY CATH POWER PICC 5FR
|
Facility
|
OP
|
$1,998.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
7001686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.50 |
| Max. Negotiated Rate |
$1,898.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,198.80
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cigna Commercial |
$1,698.30
|
| Rate for Payer: First Health Commercial |
$1,798.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,798.20
|
| Rate for Payer: GEHA Commercial |
$1,598.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,798.20
|
| Rate for Payer: Humana ChoiceCare |
$519.48
|
| Rate for Payer: Multiplan All |
$1,818.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,198.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,398.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,798.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,898.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,498.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,758.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$499.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,858.14
|
| Rate for Payer: Zelis Auto |
$799.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$999.00
|
|
|
IMPLT TRAY GROSHONG 9FR DUAL LUMEN
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
7002388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.60 |
| Max. Negotiated Rate |
$398.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$335.20
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cigna Commercial |
$356.15
|
| Rate for Payer: First Health Commercial |
$377.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$377.10
|
| Rate for Payer: GEHA Commercial |
$293.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$377.10
|
| Rate for Payer: Multiplan All |
$381.29
|
| Rate for Payer: OMNI Networks Commercial |
$293.30
|
| Rate for Payer: One Health Plan PPO/POS |
$377.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$398.05
|
| Rate for Payer: Three Rivers Provider Network All |
$314.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$389.67
|
| Rate for Payer: Zelis Auto |
$167.60
|
|
|
IMPLT TRAY GROSHONG 9FR DUAL LUMEN
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
7002388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.75 |
| Max. Negotiated Rate |
$398.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$251.40
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cigna Commercial |
$356.15
|
| Rate for Payer: First Health Commercial |
$377.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$377.10
|
| Rate for Payer: GEHA Commercial |
$335.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$377.10
|
| Rate for Payer: Humana ChoiceCare |
$108.94
|
| Rate for Payer: Multiplan All |
$381.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$251.40
|
| Rate for Payer: OMNI Networks Commercial |
$293.30
|
| Rate for Payer: One Health Plan PPO/POS |
$377.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$398.05
|
| Rate for Payer: Three Rivers Provider Network All |
$314.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$368.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$104.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$389.67
|
| Rate for Payer: Zelis Auto |
$167.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$209.50
|
|
|
IMPLT TRAY HUMERAL 44+10
|
Facility
|
IP
|
$6,547.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,618.80 |
| Max. Negotiated Rate |
$6,219.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,237.60
|
| Rate for Payer: Cash Price |
$3,928.20
|
| Rate for Payer: Cash Price |
$3,928.20
|
| Rate for Payer: Cigna Commercial |
$5,564.95
|
| Rate for Payer: First Health Commercial |
$5,892.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,892.30
|
| Rate for Payer: GEHA Commercial |
$4,582.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,892.30
|
| Rate for Payer: Multiplan All |
$5,957.77
|
| Rate for Payer: OMNI Networks Commercial |
$4,582.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,892.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,219.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,910.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,088.71
|
| Rate for Payer: Zelis Auto |
$2,618.80
|
|
|
IMPLT TRAY HUMERAL 44+10
|
Facility
|
OP
|
$6,547.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,636.75 |
| Max. Negotiated Rate |
$6,219.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,928.20
|
| Rate for Payer: Cash Price |
$3,928.20
|
| Rate for Payer: Cash Price |
$3,928.20
|
| Rate for Payer: Cigna Commercial |
$5,564.95
|
| Rate for Payer: First Health Commercial |
$5,892.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,892.30
|
| Rate for Payer: GEHA Commercial |
$5,237.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,892.30
|
| Rate for Payer: Humana ChoiceCare |
$1,702.22
|
| Rate for Payer: Multiplan All |
$5,957.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,928.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,582.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,892.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,219.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,910.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,761.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,636.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,088.71
|
| Rate for Payer: Zelis Auto |
$2,618.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,273.50
|
|
