|
IMPLT WASHER 4.0MM
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.25 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$215.05
|
| Rate for Payer: First Health Commercial |
$227.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$227.70
|
| Rate for Payer: GEHA Commercial |
$202.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$227.70
|
| Rate for Payer: Humana ChoiceCare |
$65.78
|
| Rate for Payer: Multiplan All |
$230.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$151.80
|
| Rate for Payer: OMNI Networks Commercial |
$177.10
|
| Rate for Payer: One Health Plan PPO/POS |
$227.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$240.35
|
| Rate for Payer: Three Rivers Provider Network All |
$189.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$222.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$235.29
|
| Rate for Payer: Zelis Auto |
$101.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$126.50
|
|
|
IMPLT WASHER 6.0
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7006760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$295.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Humana ChoiceCare |
$95.94
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$221.40
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$324.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$184.50
|
|
|
IMPLT WASHER 6.0
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7006760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$295.20
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$258.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: Zelis Auto |
$147.60
|
|
|
IMPLT WASHER 6.5MM
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$441.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$372.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$395.25
|
| Rate for Payer: First Health Commercial |
$418.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$418.50
|
| Rate for Payer: GEHA Commercial |
$325.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$418.50
|
| Rate for Payer: Multiplan All |
$423.15
|
| Rate for Payer: OMNI Networks Commercial |
$325.50
|
| Rate for Payer: One Health Plan PPO/POS |
$418.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$441.75
|
| Rate for Payer: Three Rivers Provider Network All |
$348.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$432.45
|
| Rate for Payer: Zelis Auto |
$186.00
|
|
|
IMPLT WASHER 6.5MM
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$227.20
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$198.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
|
|
IMPLT WASHER 6.5MM
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$441.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$395.25
|
| Rate for Payer: First Health Commercial |
$418.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$418.50
|
| Rate for Payer: GEHA Commercial |
$372.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$418.50
|
| Rate for Payer: Humana ChoiceCare |
$120.90
|
| Rate for Payer: Multiplan All |
$423.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$279.00
|
| Rate for Payer: OMNI Networks Commercial |
$325.50
|
| Rate for Payer: One Health Plan PPO/POS |
$418.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$441.75
|
| Rate for Payer: Three Rivers Provider Network All |
$348.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$409.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$432.45
|
| Rate for Payer: Zelis Auto |
$186.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$232.50
|
|
|
IMPLT WASHER 6.5MM
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$227.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Humana ChoiceCare |
$73.84
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$170.40
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$249.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.00
|
|
|
IMPLT WASHER 6.5MM ROUND
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$388.80
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$413.10
|
| Rate for Payer: First Health Commercial |
$437.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$437.40
|
| Rate for Payer: GEHA Commercial |
$340.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$437.40
|
| Rate for Payer: Multiplan All |
$442.26
|
| Rate for Payer: OMNI Networks Commercial |
$340.20
|
| Rate for Payer: One Health Plan PPO/POS |
$437.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$461.70
|
| Rate for Payer: Three Rivers Provider Network All |
$364.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.98
|
| Rate for Payer: Zelis Auto |
$194.40
|
|
|
IMPLT WASHER 6.5MM ROUND
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$413.10
|
| Rate for Payer: First Health Commercial |
$437.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$437.40
|
| Rate for Payer: GEHA Commercial |
$388.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$437.40
|
| Rate for Payer: Humana ChoiceCare |
$126.36
|
| Rate for Payer: Multiplan All |
$442.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$291.60
|
| Rate for Payer: OMNI Networks Commercial |
$340.20
|
| Rate for Payer: One Health Plan PPO/POS |
$437.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$461.70
|
| Rate for Payer: Three Rivers Provider Network All |
$364.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$427.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.98
|
| Rate for Payer: Zelis Auto |
$194.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$243.00
|
|
|
IMPLT WASHER 6.9MM
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$220.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Humana ChoiceCare |
$71.76
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$165.60
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$242.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: Zelis Auto |
$110.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$138.00
|
|
|
IMPLT WASHER 6.9MM
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$220.80
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$193.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: Zelis Auto |
$110.40
|
|
|
IMPLT WASHER 7.0MM
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.25 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$228.65
|
| Rate for Payer: First Health Commercial |
$242.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$242.10
|
| Rate for Payer: GEHA Commercial |
$215.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$242.10
|
| Rate for Payer: Humana ChoiceCare |
$69.94
|
| Rate for Payer: Multiplan All |
$244.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$161.40
|
| Rate for Payer: OMNI Networks Commercial |
$188.30
|
| Rate for Payer: One Health Plan PPO/POS |
$242.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$255.55
|
| Rate for Payer: Three Rivers Provider Network All |
$201.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$236.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$250.17
|
| Rate for Payer: Zelis Auto |
$107.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$134.50
|
|
|
IMPLT WASHER 7.0MM
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$215.20
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$228.65
|
| Rate for Payer: First Health Commercial |
$242.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$242.10
|
| Rate for Payer: GEHA Commercial |
$188.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$242.10
|
| Rate for Payer: Multiplan All |
$244.79
|
| Rate for Payer: OMNI Networks Commercial |
$188.30
|
| Rate for Payer: One Health Plan PPO/POS |
$242.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$255.55
|
| Rate for Payer: Three Rivers Provider Network All |
$201.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$250.17
|
| Rate for Payer: Zelis Auto |
$107.60
|
|
|
IMPLT WASHER 8MM X4MM
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$358.40
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$380.80
|
| Rate for Payer: First Health Commercial |
$403.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$403.20
|
| Rate for Payer: GEHA Commercial |
$313.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$403.20
|
| Rate for Payer: Multiplan All |
$407.68
|
| Rate for Payer: OMNI Networks Commercial |
$313.60
|
| Rate for Payer: One Health Plan PPO/POS |
$403.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$425.60
|
| Rate for Payer: Three Rivers Provider Network All |
$336.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$416.64
|
| Rate for Payer: Zelis Auto |
$179.20
|
|
|
IMPLT WASHER 8MM X4MM
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$380.80
|
| Rate for Payer: First Health Commercial |
$403.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$403.20
|
| Rate for Payer: GEHA Commercial |
$358.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$403.20
|
| Rate for Payer: Humana ChoiceCare |
$116.48
|
| Rate for Payer: Multiplan All |
$407.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$268.80
|
| Rate for Payer: OMNI Networks Commercial |
$313.60
|
| Rate for Payer: One Health Plan PPO/POS |
$403.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$425.60
|
| Rate for Payer: Three Rivers Provider Network All |
$336.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$394.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$112.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$416.64
|
| Rate for Payer: Zelis Auto |
$179.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$224.00
|
|
|
IMPLT WASHER ASNIS 4.0MM
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$177.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Humana ChoiceCare |
$57.72
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$133.20
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$195.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$111.00
|
|
|
IMPLT WASHER ASNIS 4.0MM
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$177.60
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$155.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
|
|
IMPLT WASHER ASNIS 5.0MM
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.75 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$191.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Humana ChoiceCare |
$62.14
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$143.40
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$210.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$119.50
|
|
|
IMPLT WASHER ASNIS 5.0MM
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$191.20
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$167.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
|
|
IMPLT WASHER O.D. 7.0MM
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$200.60
|
| Rate for Payer: First Health Commercial |
$212.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$212.40
|
| Rate for Payer: GEHA Commercial |
$188.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$212.40
|
| Rate for Payer: Humana ChoiceCare |
$61.36
|
| Rate for Payer: Multiplan All |
$214.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$141.60
|
| Rate for Payer: OMNI Networks Commercial |
$165.20
|
| Rate for Payer: One Health Plan PPO/POS |
$212.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$224.20
|
| Rate for Payer: Three Rivers Provider Network All |
$177.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$207.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$219.48
|
| Rate for Payer: Zelis Auto |
$94.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$118.00
|
|
|
IMPLT WASHER O.D. 7.0MM
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$188.80
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$200.60
|
| Rate for Payer: First Health Commercial |
$212.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$212.40
|
| Rate for Payer: GEHA Commercial |
$165.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$212.40
|
| Rate for Payer: Multiplan All |
$214.76
|
| Rate for Payer: OMNI Networks Commercial |
$165.20
|
| Rate for Payer: One Health Plan PPO/POS |
$212.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$224.20
|
| Rate for Payer: Three Rivers Provider Network All |
$177.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$219.48
|
| Rate for Payer: Zelis Auto |
$94.40
|
|
|
IMPLT WASHER WRIST 1.2MM
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$189.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Humana ChoiceCare |
$61.62
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.20
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$208.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$118.50
|
|
|
IMPLT WASHER WRIST 1.2MM
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$189.60
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$165.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
|
|
IMPLT WASHER WRIST 2.3MM
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$802.00 |
| Max. Negotiated Rate |
$1,904.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,604.00
|
| Rate for Payer: Cash Price |
$1,203.00
|
| Rate for Payer: Cash Price |
$1,203.00
|
| Rate for Payer: Cigna Commercial |
$1,704.25
|
| Rate for Payer: First Health Commercial |
$1,804.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,804.50
|
| Rate for Payer: GEHA Commercial |
$1,403.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,804.50
|
| Rate for Payer: Multiplan All |
$1,824.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,403.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,804.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,904.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,503.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,864.65
|
| Rate for Payer: Zelis Auto |
$802.00
|
|
|
IMPLT WASHER WRIST 2.3MM
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.25 |
| Max. Negotiated Rate |
$1,904.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,203.00
|
| Rate for Payer: Cash Price |
$1,203.00
|
| Rate for Payer: Cash Price |
$1,203.00
|
| Rate for Payer: Cigna Commercial |
$1,704.25
|
| Rate for Payer: First Health Commercial |
$1,804.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,804.50
|
| Rate for Payer: GEHA Commercial |
$1,604.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,804.50
|
| Rate for Payer: Humana ChoiceCare |
$521.30
|
| Rate for Payer: Multiplan All |
$1,824.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,203.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,403.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,804.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,904.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,503.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,764.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$501.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,864.65
|
| Rate for Payer: Zelis Auto |
$802.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,002.50
|
|
