|
IMPLT WIRE K GAMMA 03.2X450MM
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$515.20
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$547.40
|
| Rate for Payer: First Health Commercial |
$579.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$579.60
|
| Rate for Payer: GEHA Commercial |
$450.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$579.60
|
| Rate for Payer: Multiplan All |
$586.04
|
| Rate for Payer: OMNI Networks Commercial |
$450.80
|
| Rate for Payer: One Health Plan PPO/POS |
$579.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$611.80
|
| Rate for Payer: Three Rivers Provider Network All |
$483.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$598.92
|
| Rate for Payer: Zelis Auto |
$257.60
|
|
|
IMPLT WIRE K GAMMA 03.2X450MM
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$547.40
|
| Rate for Payer: First Health Commercial |
$579.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$579.60
|
| Rate for Payer: GEHA Commercial |
$515.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$579.60
|
| Rate for Payer: Humana ChoiceCare |
$167.44
|
| Rate for Payer: Multiplan All |
$586.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$386.40
|
| Rate for Payer: OMNI Networks Commercial |
$450.80
|
| Rate for Payer: One Health Plan PPO/POS |
$579.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$611.80
|
| Rate for Payer: Three Rivers Provider Network All |
$483.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$566.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$161.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$598.92
|
| Rate for Payer: Zelis Auto |
$257.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$322.00
|
|
|
IMPLT WIRE-K OLIVE 1.2MM
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.75 |
| Max. Negotiated Rate |
$762.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$481.80
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cigna Commercial |
$682.55
|
| Rate for Payer: First Health Commercial |
$722.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$722.70
|
| Rate for Payer: GEHA Commercial |
$642.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$722.70
|
| Rate for Payer: Humana ChoiceCare |
$208.78
|
| Rate for Payer: Multiplan All |
$730.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$481.80
|
| Rate for Payer: OMNI Networks Commercial |
$562.10
|
| Rate for Payer: One Health Plan PPO/POS |
$722.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$762.85
|
| Rate for Payer: Three Rivers Provider Network All |
$602.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$706.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$200.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$746.79
|
| Rate for Payer: Zelis Auto |
$321.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$401.50
|
|
|
IMPLT WIRE-K OLIVE 1.2MM
|
Facility
|
IP
|
$803.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$762.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$642.40
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cigna Commercial |
$682.55
|
| Rate for Payer: First Health Commercial |
$722.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$722.70
|
| Rate for Payer: GEHA Commercial |
$562.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$722.70
|
| Rate for Payer: Multiplan All |
$730.73
|
| Rate for Payer: OMNI Networks Commercial |
$562.10
|
| Rate for Payer: One Health Plan PPO/POS |
$722.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$762.85
|
| Rate for Payer: Three Rivers Provider Network All |
$602.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$746.79
|
| Rate for Payer: Zelis Auto |
$321.20
|
|
|
IMPLT WIRE-K OLIVE 2.0MM
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$193.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Humana ChoiceCare |
$62.92
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.20
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.00
|
|
|
IMPLT WIRE-K OLIVE 2.0MM
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$193.60
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
|
|
IMPLT WIRE K OLIVE STOP
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.75 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$373.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$373.50
|
| Rate for Payer: GEHA Commercial |
$332.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$373.50
|
| Rate for Payer: Humana ChoiceCare |
$107.90
|
| Rate for Payer: Multiplan All |
$377.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$249.00
|
| Rate for Payer: OMNI Networks Commercial |
$290.50
|
| Rate for Payer: One Health Plan PPO/POS |
$373.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$394.25
|
| Rate for Payer: Three Rivers Provider Network All |
$311.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$365.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$103.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$385.95
|
| Rate for Payer: Zelis Auto |
$166.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$207.50
|
|
|
IMPLT WIRE K OLIVE STOP
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$332.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$373.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$373.50
|
| Rate for Payer: GEHA Commercial |
$290.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$373.50
|
| Rate for Payer: Multiplan All |
$377.65
|
| Rate for Payer: OMNI Networks Commercial |
$290.50
|
| Rate for Payer: One Health Plan PPO/POS |
$373.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$394.25
|
| Rate for Payer: Three Rivers Provider Network All |
$311.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$385.95
|
| Rate for Payer: Zelis Auto |
$166.00
|
|
|
IMPLT WIRE K PERI-LOC 1.25MM
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.60 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$275.20
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cigna Commercial |
$292.40
|
| Rate for Payer: First Health Commercial |
$309.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$309.60
|
| Rate for Payer: GEHA Commercial |
$240.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$309.60
|
| Rate for Payer: Multiplan All |
$313.04
|
| Rate for Payer: OMNI Networks Commercial |
$240.80
|
| Rate for Payer: One Health Plan PPO/POS |
$309.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$326.80
|
| Rate for Payer: Three Rivers Provider Network All |
$258.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$319.92
|
| Rate for Payer: Zelis Auto |
$137.60
|
|
|
IMPLT WIRE K PERI-LOC 1.25MM
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cigna Commercial |
$292.40
|
| Rate for Payer: First Health Commercial |
$309.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$309.60
|
| Rate for Payer: GEHA Commercial |
$275.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$309.60
|
| Rate for Payer: Humana ChoiceCare |
$89.44
|
| Rate for Payer: Multiplan All |
$313.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$206.40
|
| Rate for Payer: OMNI Networks Commercial |
$240.80
|
| Rate for Payer: One Health Plan PPO/POS |
$309.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$326.80
|
| Rate for Payer: Three Rivers Provider Network All |
$258.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$302.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$319.92
|
| Rate for Payer: Zelis Auto |
$137.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$172.00
|
|
|
IMPLT WIRE-K PERI-LOC 1.6MM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$158.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Humana ChoiceCare |
$51.48
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$118.80
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$174.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.00
|
|
|
IMPLT WIRE-K PERI-LOC 1.6MM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.40
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$138.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
|
|
IMPLT WIRE K POINT TROCAR 1.0MM
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
|
|
IMPLT WIRE K POINT TROCAR 1.0MM
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$35.36
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$81.60
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.00
|
|
|
IMPLT WIRE-K SMOOTH TROCAR POINT 062
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.80 |
| Max. Negotiated Rate |
$980.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$825.60
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cigna Commercial |
$877.20
|
| Rate for Payer: First Health Commercial |
$928.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$928.80
|
| Rate for Payer: GEHA Commercial |
$722.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$928.80
|
| Rate for Payer: Multiplan All |
$939.12
|
| Rate for Payer: OMNI Networks Commercial |
$722.40
|
| Rate for Payer: One Health Plan PPO/POS |
$928.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$980.40
|
| Rate for Payer: Three Rivers Provider Network All |
$774.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$959.76
|
| Rate for Payer: Zelis Auto |
$412.80
|
|
|
IMPLT WIRE-K SMOOTH TROCAR POINT 062
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.00 |
| Max. Negotiated Rate |
$980.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cigna Commercial |
$877.20
|
| Rate for Payer: First Health Commercial |
$928.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$928.80
|
| Rate for Payer: GEHA Commercial |
$825.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$928.80
|
| Rate for Payer: Humana ChoiceCare |
$268.32
|
| Rate for Payer: Multiplan All |
$939.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$619.20
|
| Rate for Payer: OMNI Networks Commercial |
$722.40
|
| Rate for Payer: One Health Plan PPO/POS |
$928.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$980.40
|
| Rate for Payer: Three Rivers Provider Network All |
$774.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$908.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$258.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$959.76
|
| Rate for Payer: Zelis Auto |
$412.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$516.00
|
|
|
IMPLT WIRE-K STERILE 03X285MM
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.60 |
| Max. Negotiated Rate |
$588.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$495.20
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$526.15
|
| Rate for Payer: First Health Commercial |
$557.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$557.10
|
| Rate for Payer: GEHA Commercial |
$433.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$557.10
|
| Rate for Payer: Multiplan All |
$563.29
|
| Rate for Payer: OMNI Networks Commercial |
$433.30
|
| Rate for Payer: One Health Plan PPO/POS |
$557.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$588.05
|
| Rate for Payer: Three Rivers Provider Network All |
$464.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$575.67
|
| Rate for Payer: Zelis Auto |
$247.60
|
|
|
IMPLT WIRE-K STERILE 03X285MM
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$588.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$526.15
|
| Rate for Payer: First Health Commercial |
$557.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$557.10
|
| Rate for Payer: GEHA Commercial |
$495.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$557.10
|
| Rate for Payer: Humana ChoiceCare |
$160.94
|
| Rate for Payer: Multiplan All |
$563.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$371.40
|
| Rate for Payer: OMNI Networks Commercial |
$433.30
|
| Rate for Payer: One Health Plan PPO/POS |
$557.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$588.05
|
| Rate for Payer: Three Rivers Provider Network All |
$464.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$544.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$154.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$575.67
|
| Rate for Payer: Zelis Auto |
$247.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$309.50
|
|
|
IMPLT WIRE K STERILE 1.8X310MM
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$703.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$629.00
|
| Rate for Payer: First Health Commercial |
$666.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$666.00
|
| Rate for Payer: GEHA Commercial |
$592.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$666.00
|
| Rate for Payer: Humana ChoiceCare |
$192.40
|
| Rate for Payer: Multiplan All |
$673.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$444.00
|
| Rate for Payer: OMNI Networks Commercial |
$518.00
|
| Rate for Payer: One Health Plan PPO/POS |
$666.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$703.00
|
| Rate for Payer: Three Rivers Provider Network All |
$555.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$651.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$185.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$688.20
|
| Rate for Payer: Zelis Auto |
$296.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$370.00
|
|
|
IMPLT WIRE K STERILE 1.8X310MM
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.00 |
| Max. Negotiated Rate |
$703.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$592.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$629.00
|
| Rate for Payer: First Health Commercial |
$666.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$666.00
|
| Rate for Payer: GEHA Commercial |
$518.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$666.00
|
| Rate for Payer: Multiplan All |
$673.40
|
| Rate for Payer: OMNI Networks Commercial |
$518.00
|
| Rate for Payer: One Health Plan PPO/POS |
$666.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$703.00
|
| Rate for Payer: Three Rivers Provider Network All |
$555.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$688.20
|
| Rate for Payer: Zelis Auto |
$296.00
|
|
|
IMPLT WIRE-K SYSTEM GAMMA
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.25 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$711.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| Rate for Payer: Humana ChoiceCare |
$231.14
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$533.40
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$782.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$222.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: Zelis Auto |
$355.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$444.50
|
|
|
IMPLT WIRE-K SYSTEM GAMMA
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.60 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$711.20
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$622.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: Zelis Auto |
$355.60
|
|
|
IMPLT WIRE-K THREADED .045
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$651.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.80
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$583.10
|
| Rate for Payer: First Health Commercial |
$617.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$617.40
|
| Rate for Payer: GEHA Commercial |
$480.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$617.40
|
| Rate for Payer: Multiplan All |
$624.26
|
| Rate for Payer: OMNI Networks Commercial |
$480.20
|
| Rate for Payer: One Health Plan PPO/POS |
$617.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$651.70
|
| Rate for Payer: Three Rivers Provider Network All |
$514.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.98
|
| Rate for Payer: Zelis Auto |
$274.40
|
|
|
IMPLT WIRE-K THREADED .045
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$651.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$411.60
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$583.10
|
| Rate for Payer: First Health Commercial |
$617.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$617.40
|
| Rate for Payer: GEHA Commercial |
$548.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$617.40
|
| Rate for Payer: Humana ChoiceCare |
$178.36
|
| Rate for Payer: Multiplan All |
$624.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$411.60
|
| Rate for Payer: OMNI Networks Commercial |
$480.20
|
| Rate for Payer: One Health Plan PPO/POS |
$617.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$651.70
|
| Rate for Payer: Three Rivers Provider Network All |
$514.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$603.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.98
|
| Rate for Payer: Zelis Auto |
$274.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.00
|
|
|
IMPLT WIRE-K THREADED .062 OLIVO
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$506.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$426.40
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$453.05
|
| Rate for Payer: First Health Commercial |
$479.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$479.70
|
| Rate for Payer: GEHA Commercial |
$373.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$479.70
|
| Rate for Payer: Multiplan All |
$485.03
|
| Rate for Payer: OMNI Networks Commercial |
$373.10
|
| Rate for Payer: One Health Plan PPO/POS |
$479.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.35
|
| Rate for Payer: Three Rivers Provider Network All |
$399.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$495.69
|
| Rate for Payer: Zelis Auto |
$213.20
|
|
