|
IMPLT WIRE K .062X15.2CM
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$79.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Humana ChoiceCare |
$25.74
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.40
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$87.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: Zelis Auto |
$39.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$49.50
|
|
|
IMPLT WIRE K .062X15.2CM
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.20
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$69.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: Zelis Auto |
$39.60
|
|
|
IMPLT WIRE-K .08
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$236.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$250.75
|
| Rate for Payer: First Health Commercial |
$265.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$265.50
|
| Rate for Payer: GEHA Commercial |
$206.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$265.50
|
| Rate for Payer: Multiplan All |
$268.45
|
| Rate for Payer: OMNI Networks Commercial |
$206.50
|
| Rate for Payer: One Health Plan PPO/POS |
$265.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$280.25
|
| Rate for Payer: Three Rivers Provider Network All |
$221.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$274.35
|
| Rate for Payer: Zelis Auto |
$118.00
|
|
|
IMPLT WIRE-K .08
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$250.75
|
| Rate for Payer: First Health Commercial |
$265.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$265.50
|
| Rate for Payer: GEHA Commercial |
$236.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$265.50
|
| Rate for Payer: Humana ChoiceCare |
$76.70
|
| Rate for Payer: Multiplan All |
$268.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$177.00
|
| Rate for Payer: OMNI Networks Commercial |
$206.50
|
| Rate for Payer: One Health Plan PPO/POS |
$265.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$280.25
|
| Rate for Payer: Three Rivers Provider Network All |
$221.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$259.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$274.35
|
| Rate for Payer: Zelis Auto |
$118.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$147.50
|
|
|
IMPLT WIRE-K 1.0X160MM
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$180.20
|
| Rate for Payer: First Health Commercial |
$190.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$190.80
|
| Rate for Payer: GEHA Commercial |
$169.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$190.80
|
| Rate for Payer: Humana ChoiceCare |
$55.12
|
| Rate for Payer: Multiplan All |
$192.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.20
|
| Rate for Payer: OMNI Networks Commercial |
$148.40
|
| Rate for Payer: One Health Plan PPO/POS |
$190.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$201.40
|
| Rate for Payer: Three Rivers Provider Network All |
$159.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$186.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$197.16
|
| Rate for Payer: Zelis Auto |
$84.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.00
|
|
|
IMPLT WIRE-K 1.0X160MM
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$169.60
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$180.20
|
| Rate for Payer: First Health Commercial |
$190.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$190.80
|
| Rate for Payer: GEHA Commercial |
$148.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$190.80
|
| Rate for Payer: Multiplan All |
$192.92
|
| Rate for Payer: OMNI Networks Commercial |
$148.40
|
| Rate for Payer: One Health Plan PPO/POS |
$190.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$201.40
|
| Rate for Payer: Three Rivers Provider Network All |
$159.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$197.16
|
| Rate for Payer: Zelis Auto |
$84.80
|
|
|
IMPLT WIRE K 1.0X70MM
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$764.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$644.00
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cigna Commercial |
$684.25
|
| Rate for Payer: First Health Commercial |
$724.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$724.50
|
| Rate for Payer: GEHA Commercial |
$563.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$724.50
|
| Rate for Payer: Multiplan All |
$732.55
|
| Rate for Payer: OMNI Networks Commercial |
$563.50
|
| Rate for Payer: One Health Plan PPO/POS |
$724.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$764.75
|
| Rate for Payer: Three Rivers Provider Network All |
$603.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$748.65
|
| Rate for Payer: Zelis Auto |
$322.00
|
|
|
IMPLT WIRE K 1.0X70MM
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.25 |
| Max. Negotiated Rate |
$764.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$483.00
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cigna Commercial |
$684.25
|
| Rate for Payer: First Health Commercial |
$724.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$724.50
|
| Rate for Payer: GEHA Commercial |
$644.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$724.50
|
| Rate for Payer: Humana ChoiceCare |
$209.30
|
| Rate for Payer: Multiplan All |
$732.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$483.00
|
| Rate for Payer: OMNI Networks Commercial |
$563.50
|
| Rate for Payer: One Health Plan PPO/POS |
$724.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$764.75
|
| Rate for Payer: Three Rivers Provider Network All |
$603.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$708.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$201.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$748.65
|
| Rate for Payer: Zelis Auto |
$322.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$402.50
|
|
|
IMPLT WIRE K 1.14MM
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.80
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$84.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
|
|
IMPLT WIRE K 1.14MM
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$96.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Humana ChoiceCare |
$31.46
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.60
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$106.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$60.50
|
|
|
IMPLT WIRE K 1.25MM 900.721
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$223.20
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$195.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: Zelis Auto |
$111.60
|
|
|
IMPLT WIRE K 1.25MM 900.721
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$223.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Humana ChoiceCare |
$72.54
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$167.40
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$245.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$139.50
|
|
|
IMPLT WIRE K 1.25MM PERI-LOCK
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.00
|
| Rate for Payer: GEHA Commercial |
$152.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.00
|
| Rate for Payer: Humana ChoiceCare |
$49.40
|
| Rate for Payer: Multiplan All |
$172.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.00
|
| Rate for Payer: OMNI Networks Commercial |
$133.00
|
| Rate for Payer: One Health Plan PPO/POS |
$171.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$180.50
|
| Rate for Payer: Three Rivers Provider Network All |
$142.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$167.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$176.70
|
| Rate for Payer: Zelis Auto |
$76.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$95.00
|
|
|
IMPLT WIRE K 1.25MM PERI-LOCK
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.00
|
| Rate for Payer: GEHA Commercial |
$133.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.00
|
| Rate for Payer: Multiplan All |
$172.90
|
| Rate for Payer: OMNI Networks Commercial |
$133.00
|
| Rate for Payer: One Health Plan PPO/POS |
$171.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$180.50
|
| Rate for Payer: Three Rivers Provider Network All |
$142.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$176.70
|
| Rate for Payer: Zelis Auto |
$76.00
|
|
|
IMPLT WIRE-K 1.25X150MM
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$58.65
|
| Rate for Payer: First Health Commercial |
$62.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$62.10
|
| Rate for Payer: GEHA Commercial |
$55.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$62.10
|
| Rate for Payer: Humana ChoiceCare |
$17.94
|
| Rate for Payer: Multiplan All |
$62.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$41.40
|
| Rate for Payer: OMNI Networks Commercial |
$48.30
|
| Rate for Payer: One Health Plan PPO/POS |
$62.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$65.55
|
| Rate for Payer: Three Rivers Provider Network All |
$51.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$60.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$64.17
|
| Rate for Payer: Zelis Auto |
$27.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$34.50
|
|
|
IMPLT WIRE-K 1.25X150MM
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$55.20
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$58.65
|
| Rate for Payer: First Health Commercial |
$62.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$62.10
|
| Rate for Payer: GEHA Commercial |
$48.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$62.10
|
| Rate for Payer: Multiplan All |
$62.79
|
| Rate for Payer: OMNI Networks Commercial |
$48.30
|
| Rate for Payer: One Health Plan PPO/POS |
$62.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$65.55
|
| Rate for Payer: Three Rivers Provider Network All |
$51.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$64.17
|
| Rate for Payer: Zelis Auto |
$27.60
|
|
|
IMPLT WIRE-K 1.4X100MM
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Humana ChoiceCare |
$38.22
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$88.20
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$129.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$73.50
|
|
|
IMPLT WIRE-K 1.4X100MM
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$117.60
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$102.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: Zelis Auto |
$58.80
|
|
|
IMPLT WIRE-K 1.4X150MM
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.60 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$359.20
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$381.65
|
| Rate for Payer: First Health Commercial |
$404.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$404.10
|
| Rate for Payer: GEHA Commercial |
$314.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$404.10
|
| Rate for Payer: Multiplan All |
$408.59
|
| Rate for Payer: OMNI Networks Commercial |
$314.30
|
| Rate for Payer: One Health Plan PPO/POS |
$404.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$426.55
|
| Rate for Payer: Three Rivers Provider Network All |
$336.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$417.57
|
| Rate for Payer: Zelis Auto |
$179.60
|
|
|
IMPLT WIRE-K 1.4X150MM
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.25 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$381.65
|
| Rate for Payer: First Health Commercial |
$404.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$404.10
|
| Rate for Payer: GEHA Commercial |
$359.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$404.10
|
| Rate for Payer: Humana ChoiceCare |
$116.74
|
| Rate for Payer: Multiplan All |
$408.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$269.40
|
| Rate for Payer: OMNI Networks Commercial |
$314.30
|
| Rate for Payer: One Health Plan PPO/POS |
$404.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$426.55
|
| Rate for Payer: Three Rivers Provider Network All |
$336.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$395.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$112.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$417.57
|
| Rate for Payer: Zelis Auto |
$179.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$224.50
|
|
|
IMPLT WIRE-K 150MM 1MM KRSH SS TROC
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$58.65
|
| Rate for Payer: First Health Commercial |
$62.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$62.10
|
| Rate for Payer: GEHA Commercial |
$55.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$62.10
|
| Rate for Payer: Humana ChoiceCare |
$17.94
|
| Rate for Payer: Multiplan All |
$62.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$41.40
|
| Rate for Payer: OMNI Networks Commercial |
$48.30
|
| Rate for Payer: One Health Plan PPO/POS |
$62.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$65.55
|
| Rate for Payer: Three Rivers Provider Network All |
$51.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$60.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$64.17
|
| Rate for Payer: Zelis Auto |
$27.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$34.50
|
|
|
IMPLT WIRE-K 150MM 1MM KRSH SS TROC
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$55.20
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$58.65
|
| Rate for Payer: First Health Commercial |
$62.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$62.10
|
| Rate for Payer: GEHA Commercial |
$48.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$62.10
|
| Rate for Payer: Multiplan All |
$62.79
|
| Rate for Payer: OMNI Networks Commercial |
$48.30
|
| Rate for Payer: One Health Plan PPO/POS |
$62.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$65.55
|
| Rate for Payer: Three Rivers Provider Network All |
$51.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$64.17
|
| Rate for Payer: Zelis Auto |
$27.60
|
|
|
IMPLT WIRE K 1.6 (0.62)
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$70.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: Zelis Auto |
$40.00
|
|
|
IMPLT WIRE K 1.6 (0.62)
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$80.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Humana ChoiceCare |
$26.00
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.00
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$88.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$50.00
|
|
|
IMPLT WIRE K 1.6MM
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$58.65
|
| Rate for Payer: First Health Commercial |
$62.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$62.10
|
| Rate for Payer: GEHA Commercial |
$55.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$62.10
|
| Rate for Payer: Humana ChoiceCare |
$17.94
|
| Rate for Payer: Multiplan All |
$62.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$41.40
|
| Rate for Payer: OMNI Networks Commercial |
$48.30
|
| Rate for Payer: One Health Plan PPO/POS |
$62.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$65.55
|
| Rate for Payer: Three Rivers Provider Network All |
$51.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$60.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$64.17
|
| Rate for Payer: Zelis Auto |
$27.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$34.50
|
|
