|
IMPLT WIRE K 1.6MM
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006222
|
|
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 1.6MMX100MM
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.25 |
| Max. Negotiated Rate |
$399.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$357.85
|
| Rate for Payer: First Health Commercial |
$378.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.90
|
| Rate for Payer: GEHA Commercial |
$336.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.90
|
| Rate for Payer: Humana ChoiceCare |
$109.46
|
| Rate for Payer: Multiplan All |
$383.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.60
|
| Rate for Payer: OMNI Networks Commercial |
$294.70
|
| Rate for Payer: One Health Plan PPO/POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.95
|
| Rate for Payer: Three Rivers Provider Network All |
$315.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$370.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$105.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$391.53
|
| Rate for Payer: Zelis Auto |
$168.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$210.50
|
|
|
IMPLT WIRE K 1.6MMX100MM
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.40 |
| Max. Negotiated Rate |
$399.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$336.80
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$357.85
|
| Rate for Payer: First Health Commercial |
$378.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.90
|
| Rate for Payer: GEHA Commercial |
$294.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.90
|
| Rate for Payer: Multiplan All |
$383.11
|
| Rate for Payer: OMNI Networks Commercial |
$294.70
|
| Rate for Payer: One Health Plan PPO/POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.95
|
| Rate for Payer: Three Rivers Provider Network All |
$315.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$391.53
|
| Rate for Payer: Zelis Auto |
$168.40
|
|
|
IMPLT WIRE K 1.6MMX60MM
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$276.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$89.70
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$207.00
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$303.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$172.50
|
|
|
IMPLT WIRE K 1.6MMX60MM
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$276.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$241.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
|
|
IMPLT WIRE K 1.6X150MM
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.25 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$282.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| Rate for Payer: Humana ChoiceCare |
$91.78
|
| Rate for Payer: Multiplan All |
$321.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$211.80
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.35
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$310.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$88.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.29
|
| Rate for Payer: Zelis Auto |
$141.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$176.50
|
|
|
IMPLT WIRE K 1.6X150MM
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$282.40
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$247.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| Rate for Payer: Multiplan All |
$321.23
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.35
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.29
|
| Rate for Payer: Zelis Auto |
$141.20
|
|
|
IMPLT WIRE-K 1.6X200MM
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003147
|
|
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 1.6X200MM
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003147
|
|
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 2.0MM
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$422.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$369.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
|
|
IMPLT WIRE K 2.0MM
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$422.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Humana ChoiceCare |
$137.28
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$316.80
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$464.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$132.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.00
|
|
|
IMPLT WIRE K 2.0x150MM
|
Facility
|
OP
|
$1,411.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.75 |
| Max. Negotiated Rate |
$1,340.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$846.60
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,269.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,269.90
|
| Rate for Payer: GEHA Commercial |
$1,128.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,269.90
|
| Rate for Payer: Humana ChoiceCare |
$366.86
|
| Rate for Payer: Multiplan All |
$1,284.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$846.60
|
| Rate for Payer: OMNI Networks Commercial |
$987.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,269.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,340.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,058.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,241.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$352.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,312.23
|
| Rate for Payer: Zelis Auto |
$564.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$705.50
|
|
|
IMPLT WIRE K 2.0x150MM
|
Facility
|
IP
|
$1,411.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.40 |
| Max. Negotiated Rate |
$1,340.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,128.80
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,269.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,269.90
|
| Rate for Payer: GEHA Commercial |
$987.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,269.90
|
| Rate for Payer: Multiplan All |
$1,284.01
|
| Rate for Payer: OMNI Networks Commercial |
$987.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,269.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,340.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,058.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,312.23
|
| Rate for Payer: Zelis Auto |
$564.40
|
|
|
IMPLT WIRE K 2.0X150MM
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: First Health Commercial |
$158.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$158.40
|
| Rate for Payer: GEHA Commercial |
$140.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$158.40
|
| Rate for Payer: Humana ChoiceCare |
$45.76
|
| Rate for Payer: Multiplan All |
$160.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$105.60
|
| Rate for Payer: OMNI Networks Commercial |
$123.20
|
| Rate for Payer: One Health Plan PPO/POS |
$158.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$167.20
|
| Rate for Payer: Three Rivers Provider Network All |
$132.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$154.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$163.68
|
| Rate for Payer: Zelis Auto |
$70.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$88.00
|
|
|
IMPLT WIRE K 2.0X150MM
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$140.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: First Health Commercial |
$158.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$158.40
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$158.40
|
| Rate for Payer: Multiplan All |
$160.16
|
| Rate for Payer: OMNI Networks Commercial |
$123.20
|
| Rate for Payer: One Health Plan PPO/POS |
$158.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$167.20
|
| Rate for Payer: Three Rivers Provider Network All |
$132.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$163.68
|
| Rate for Payer: Zelis Auto |
$70.40
|
|
|
IMPLT WIRE-K 2.0X150MM
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002513
|
|
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 2.0X150MM
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002513
|
|
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 2.0X350MM
|
Facility
|
OP
|
$2,526.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.50 |
| Max. Negotiated Rate |
$2,399.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cigna Commercial |
$2,147.10
|
| Rate for Payer: First Health Commercial |
$2,273.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,273.40
|
| Rate for Payer: GEHA Commercial |
$2,020.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,273.40
|
| Rate for Payer: Humana ChoiceCare |
$656.76
|
| Rate for Payer: Multiplan All |
$2,298.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,515.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,768.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,273.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,399.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,894.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,222.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$631.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,349.18
|
| Rate for Payer: Zelis Auto |
$1,010.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,263.00
|
|
|
IMPLT WIRE K 2.0X350MM
|
Facility
|
IP
|
$2,526.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.40 |
| Max. Negotiated Rate |
$2,399.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,020.80
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cigna Commercial |
$2,147.10
|
| Rate for Payer: First Health Commercial |
$2,273.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,273.40
|
| Rate for Payer: GEHA Commercial |
$1,768.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,273.40
|
| Rate for Payer: Multiplan All |
$2,298.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,768.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,273.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,399.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,894.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,349.18
|
| Rate for Payer: Zelis Auto |
$1,010.40
|
|
|
IMPLT WIRE K 3.2X230MM
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$592.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$499.20
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cigna Commercial |
$530.40
|
| Rate for Payer: First Health Commercial |
$561.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$561.60
|
| Rate for Payer: GEHA Commercial |
$436.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$561.60
|
| Rate for Payer: Multiplan All |
$567.84
|
| Rate for Payer: OMNI Networks Commercial |
$436.80
|
| Rate for Payer: One Health Plan PPO/POS |
$561.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$592.80
|
| Rate for Payer: Three Rivers Provider Network All |
$468.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$580.32
|
| Rate for Payer: Zelis Auto |
$249.60
|
|
|
IMPLT WIRE K 3.2X230MM
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$592.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cigna Commercial |
$530.40
|
| Rate for Payer: First Health Commercial |
$561.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$561.60
|
| Rate for Payer: GEHA Commercial |
$499.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$561.60
|
| Rate for Payer: Humana ChoiceCare |
$162.24
|
| Rate for Payer: Multiplan All |
$567.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.40
|
| Rate for Payer: OMNI Networks Commercial |
$436.80
|
| Rate for Payer: One Health Plan PPO/POS |
$561.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$592.80
|
| Rate for Payer: Three Rivers Provider Network All |
$468.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$549.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$156.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$580.32
|
| Rate for Payer: Zelis Auto |
$249.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$312.00
|
|
|
IMPLT WIRE K .91MM
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$128.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Humana ChoiceCare |
$41.60
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$96.00
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$140.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$80.00
|
|
|
IMPLT WIRE K .91MM
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$128.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
|
|
IMPLT WIRE K BAYONET 1.3X140MM
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.80 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$269.60
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$286.45
|
| Rate for Payer: First Health Commercial |
$303.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$303.30
|
| Rate for Payer: GEHA Commercial |
$235.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$303.30
|
| Rate for Payer: Multiplan All |
$306.67
|
| Rate for Payer: OMNI Networks Commercial |
$235.90
|
| Rate for Payer: One Health Plan PPO/POS |
$303.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$320.15
|
| Rate for Payer: Three Rivers Provider Network All |
$252.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$313.41
|
| Rate for Payer: Zelis Auto |
$134.80
|
|
|
IMPLT WIRE K BAYONET 1.3X140MM
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.25 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$286.45
|
| Rate for Payer: First Health Commercial |
$303.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$303.30
|
| Rate for Payer: GEHA Commercial |
$269.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$303.30
|
| Rate for Payer: Humana ChoiceCare |
$87.62
|
| Rate for Payer: Multiplan All |
$306.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$202.20
|
| Rate for Payer: OMNI Networks Commercial |
$235.90
|
| Rate for Payer: One Health Plan PPO/POS |
$303.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$320.15
|
| Rate for Payer: Three Rivers Provider Network All |
$252.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$296.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$313.41
|
| Rate for Payer: Zelis Auto |
$134.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.50
|
|
