|
IMPLT WIRE-K THREADED .062 OLIVO
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$506.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$319.80
|
| 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 |
$426.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$479.70
|
| Rate for Payer: Humana ChoiceCare |
$138.58
|
| Rate for Payer: Multiplan All |
$485.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$319.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$469.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$133.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$495.69
|
| Rate for Payer: Zelis Auto |
$213.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$266.50
|
|
|
IMPLT WIRE-K THREADED 1.25MM
|
Facility
|
IP
|
$1,378.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.20 |
| Max. Negotiated Rate |
$1,309.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,102.40
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$1,171.30
|
| Rate for Payer: First Health Commercial |
$1,240.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,240.20
|
| Rate for Payer: GEHA Commercial |
$964.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,240.20
|
| Rate for Payer: Multiplan All |
$1,253.98
|
| Rate for Payer: OMNI Networks Commercial |
$964.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,240.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,309.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,033.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,281.54
|
| Rate for Payer: Zelis Auto |
$551.20
|
|
|
IMPLT WIRE-K THREADED 1.25MM
|
Facility
|
OP
|
$1,378.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.50 |
| Max. Negotiated Rate |
$1,309.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$1,171.30
|
| Rate for Payer: First Health Commercial |
$1,240.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,240.20
|
| Rate for Payer: GEHA Commercial |
$1,102.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,240.20
|
| Rate for Payer: Humana ChoiceCare |
$358.28
|
| Rate for Payer: Multiplan All |
$1,253.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$826.80
|
| Rate for Payer: OMNI Networks Commercial |
$964.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,240.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,309.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,033.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,212.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$344.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,281.54
|
| Rate for Payer: Zelis Auto |
$551.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$689.00
|
|
|
IMPLT WIRE K THREADED TIP 1.25MM
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$361.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Humana ChoiceCare |
$117.52
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$271.20
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$397.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$113.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.00
|
|
|
IMPLT WIRE K THREADED TIP 1.25MM
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.60
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$316.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
|
|
IMPLT WIRE K TIP DRILL 2.0MM
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.25 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$291.00
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$412.25
|
| Rate for Payer: First Health Commercial |
$436.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$436.50
|
| Rate for Payer: GEHA Commercial |
$388.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$436.50
|
| Rate for Payer: Humana ChoiceCare |
$126.10
|
| Rate for Payer: Multiplan All |
$441.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$291.00
|
| Rate for Payer: OMNI Networks Commercial |
$339.50
|
| Rate for Payer: One Health Plan PPO/POS |
$436.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$460.75
|
| Rate for Payer: Three Rivers Provider Network All |
$363.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$426.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.05
|
| Rate for Payer: Zelis Auto |
$194.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$242.50
|
|
|
IMPLT WIRE K TIP DRILL 2.0MM
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$388.00
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$412.25
|
| Rate for Payer: First Health Commercial |
$436.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$436.50
|
| Rate for Payer: GEHA Commercial |
$339.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$436.50
|
| Rate for Payer: Multiplan All |
$441.35
|
| Rate for Payer: OMNI Networks Commercial |
$339.50
|
| Rate for Payer: One Health Plan PPO/POS |
$436.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$460.75
|
| Rate for Payer: Three Rivers Provider Network All |
$363.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.05
|
| Rate for Payer: Zelis Auto |
$194.00
|
|
|
IMPLT WIRE K TIP DRILL KRSH 234MM 2MM
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$278.80
|
| Rate for Payer: First Health Commercial |
$295.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$295.20
|
| Rate for Payer: GEHA Commercial |
$262.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$295.20
|
| Rate for Payer: Humana ChoiceCare |
$85.28
|
| Rate for Payer: Multiplan All |
$298.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$196.80
|
| Rate for Payer: OMNI Networks Commercial |
$229.60
|
| Rate for Payer: One Health Plan PPO/POS |
$295.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$311.60
|
| Rate for Payer: Three Rivers Provider Network All |
$246.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$288.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$82.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.04
|
| Rate for Payer: Zelis Auto |
$131.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$164.00
|
|
|
IMPLT WIRE K TIP DRILL KRSH 234MM 2MM
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$262.40
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$278.80
|
| Rate for Payer: First Health Commercial |
$295.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$295.20
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$295.20
|
| Rate for Payer: Multiplan All |
$298.48
|
| Rate for Payer: OMNI Networks Commercial |
$229.60
|
| Rate for Payer: One Health Plan PPO/POS |
$295.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$311.60
|
| Rate for Payer: Three Rivers Provider Network All |
$246.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.04
|
| Rate for Payer: Zelis Auto |
$131.20
|
|
|
IMPLT WIRE OLIVE XBR
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$637.50
|
| Rate for Payer: First Health Commercial |
$675.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.00
|
| Rate for Payer: GEHA Commercial |
$600.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.00
|
| Rate for Payer: Humana ChoiceCare |
$195.00
|
| Rate for Payer: Multiplan All |
$682.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$450.00
|
| Rate for Payer: OMNI Networks Commercial |
$525.00
|
| Rate for Payer: One Health Plan PPO/POS |
$675.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$712.50
|
| Rate for Payer: Three Rivers Provider Network All |
$562.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$660.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$187.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$697.50
|
| Rate for Payer: Zelis Auto |
$300.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$375.00
|
|
|
IMPLT WIRE OLIVE XBR
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$600.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$637.50
|
| Rate for Payer: First Health Commercial |
$675.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.00
|
| Rate for Payer: GEHA Commercial |
$525.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.00
|
| Rate for Payer: Multiplan All |
$682.50
|
| Rate for Payer: OMNI Networks Commercial |
$525.00
|
| Rate for Payer: One Health Plan PPO/POS |
$675.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$712.50
|
| Rate for Payer: Three Rivers Provider Network All |
$562.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$697.50
|
| Rate for Payer: Zelis Auto |
$300.00
|
|
|
IMPLT WIRE PILOT NITINOL
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.75 |
| Max. Negotiated Rate |
$455.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$287.40
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$407.15
|
| Rate for Payer: First Health Commercial |
$431.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$431.10
|
| Rate for Payer: GEHA Commercial |
$383.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$431.10
|
| Rate for Payer: Humana ChoiceCare |
$124.54
|
| Rate for Payer: Multiplan All |
$435.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.40
|
| Rate for Payer: OMNI Networks Commercial |
$335.30
|
| Rate for Payer: One Health Plan PPO/POS |
$431.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$455.05
|
| Rate for Payer: Three Rivers Provider Network All |
$359.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$421.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$445.47
|
| Rate for Payer: Zelis Auto |
$191.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$239.50
|
|
|
IMPLT WIRE PILOT NITINOL
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.60 |
| Max. Negotiated Rate |
$455.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$383.20
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$407.15
|
| Rate for Payer: First Health Commercial |
$431.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$431.10
|
| Rate for Payer: GEHA Commercial |
$335.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$431.10
|
| Rate for Payer: Multiplan All |
$435.89
|
| Rate for Payer: OMNI Networks Commercial |
$335.30
|
| Rate for Payer: One Health Plan PPO/POS |
$431.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$455.05
|
| Rate for Payer: Three Rivers Provider Network All |
$359.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$445.47
|
| Rate for Payer: Zelis Auto |
$191.60
|
|
|
IMPLT WIRE PILOT REUNION
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$203.20
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
|
|
IMPLT WIRE PILOT REUNION
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$66.04
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$152.40
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$127.00
|
|
|
IMPLT WIRE UNTHREADED
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.20 |
| Max. Negotiated Rate |
$672.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$566.40
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna Commercial |
$601.80
|
| Rate for Payer: First Health Commercial |
$637.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$637.20
|
| Rate for Payer: GEHA Commercial |
$495.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$637.20
|
| Rate for Payer: Multiplan All |
$644.28
|
| Rate for Payer: OMNI Networks Commercial |
$495.60
|
| Rate for Payer: One Health Plan PPO/POS |
$637.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$672.60
|
| Rate for Payer: Three Rivers Provider Network All |
$531.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$658.44
|
| Rate for Payer: Zelis Auto |
$283.20
|
|
|
IMPLT WIRE UNTHREADED
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$672.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna Commercial |
$601.80
|
| Rate for Payer: First Health Commercial |
$637.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$637.20
|
| Rate for Payer: GEHA Commercial |
$566.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$637.20
|
| Rate for Payer: Humana ChoiceCare |
$184.08
|
| Rate for Payer: Multiplan All |
$644.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$424.80
|
| Rate for Payer: OMNI Networks Commercial |
$495.60
|
| Rate for Payer: One Health Plan PPO/POS |
$637.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$672.60
|
| Rate for Payer: Three Rivers Provider Network All |
$531.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$623.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$177.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$658.44
|
| Rate for Payer: Zelis Auto |
$283.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.00
|
|
|
IMPLT WIRE ZIPWIRE .035 630-205B
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$226.40
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$240.55
|
| Rate for Payer: First Health Commercial |
$254.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$254.70
|
| Rate for Payer: GEHA Commercial |
$198.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$254.70
|
| Rate for Payer: Multiplan All |
$257.53
|
| Rate for Payer: OMNI Networks Commercial |
$198.10
|
| Rate for Payer: One Health Plan PPO/POS |
$254.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$268.85
|
| Rate for Payer: Three Rivers Provider Network All |
$212.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$263.19
|
| Rate for Payer: Zelis Auto |
$113.20
|
|
|
IMPLT WIRE ZIPWIRE .035 630-205B
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.75 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$240.55
|
| Rate for Payer: First Health Commercial |
$254.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$254.70
|
| Rate for Payer: GEHA Commercial |
$226.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$254.70
|
| Rate for Payer: Humana ChoiceCare |
$73.58
|
| Rate for Payer: Multiplan All |
$257.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$169.80
|
| Rate for Payer: OMNI Networks Commercial |
$198.10
|
| Rate for Payer: One Health Plan PPO/POS |
$254.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$268.85
|
| Rate for Payer: Three Rivers Provider Network All |
$212.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$249.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$263.19
|
| Rate for Payer: Zelis Auto |
$113.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$141.50
|
|
|
IMPLT WRAP NERVE COLLAGEN NEUROMEND
|
Facility
|
OP
|
$4,803.00
|
|
|
Service Code
|
CPT C9355
|
| Hospital Charge Code |
7006559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.75 |
| Max. Negotiated Rate |
$4,562.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,881.80
|
| Rate for Payer: Cash Price |
$2,881.80
|
| Rate for Payer: Cash Price |
$2,881.80
|
| Rate for Payer: Cigna Commercial |
$4,082.55
|
| Rate for Payer: First Health Commercial |
$4,322.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,322.70
|
| Rate for Payer: GEHA Commercial |
$3,842.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,322.70
|
| Rate for Payer: Humana ChoiceCare |
$1,248.78
|
| Rate for Payer: Multiplan All |
$4,370.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,881.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,362.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,322.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,562.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,602.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,226.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,200.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,466.79
|
| Rate for Payer: Zelis Auto |
$1,921.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,401.50
|
|
|
IMPLT WRAP NERVE COLLAGEN NEUROMEND
|
Facility
|
IP
|
$4,803.00
|
|
|
Service Code
|
CPT C9355
|
| Hospital Charge Code |
7006559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,921.20 |
| Max. Negotiated Rate |
$4,562.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,842.40
|
| Rate for Payer: Cash Price |
$2,881.80
|
| Rate for Payer: Cash Price |
$2,881.80
|
| Rate for Payer: Cigna Commercial |
$4,082.55
|
| Rate for Payer: First Health Commercial |
$4,322.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,322.70
|
| Rate for Payer: GEHA Commercial |
$3,362.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,322.70
|
| Rate for Payer: Multiplan All |
$4,370.73
|
| Rate for Payer: OMNI Networks Commercial |
$3,362.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,322.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,562.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,602.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,466.79
|
| Rate for Payer: Zelis Auto |
$1,921.20
|
|
|
IMPLT WRAP NERVE NEUROMEND
|
Facility
|
IP
|
$4,484.00
|
|
|
Service Code
|
CPT C9361
|
| Hospital Charge Code |
7002457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,793.60 |
| Max. Negotiated Rate |
$4,259.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,587.20
|
| Rate for Payer: Cash Price |
$2,690.40
|
| Rate for Payer: Cash Price |
$2,690.40
|
| Rate for Payer: Cigna Commercial |
$3,811.40
|
| Rate for Payer: First Health Commercial |
$4,035.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,035.60
|
| Rate for Payer: GEHA Commercial |
$3,138.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,035.60
|
| Rate for Payer: Multiplan All |
$4,080.44
|
| Rate for Payer: OMNI Networks Commercial |
$3,138.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,035.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,259.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,363.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,170.12
|
| Rate for Payer: Zelis Auto |
$1,793.60
|
|
|
IMPLT WRAP NERVE NEUROMEND
|
Facility
|
OP
|
$4,484.00
|
|
|
Service Code
|
CPT C9361
|
| Hospital Charge Code |
7002457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.00 |
| Max. Negotiated Rate |
$4,259.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,690.40
|
| Rate for Payer: Cash Price |
$2,690.40
|
| Rate for Payer: Cash Price |
$2,690.40
|
| Rate for Payer: Cigna Commercial |
$3,811.40
|
| Rate for Payer: First Health Commercial |
$4,035.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,035.60
|
| Rate for Payer: GEHA Commercial |
$3,587.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,035.60
|
| Rate for Payer: Humana ChoiceCare |
$1,165.84
|
| Rate for Payer: Multiplan All |
$4,080.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,690.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,138.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,035.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,259.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,363.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,945.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,121.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,170.12
|
| Rate for Payer: Zelis Auto |
$1,793.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,242.00
|
|
|
IMPLT ZPTIGHT ANKL SYNDESMOSIS
|
Facility
|
IP
|
$4,111.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.40 |
| Max. Negotiated Rate |
$3,905.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,288.80
|
| Rate for Payer: Cash Price |
$2,466.60
|
| Rate for Payer: Cash Price |
$2,466.60
|
| Rate for Payer: Cigna Commercial |
$3,494.35
|
| Rate for Payer: First Health Commercial |
$3,699.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,699.90
|
| Rate for Payer: GEHA Commercial |
$2,877.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,699.90
|
| Rate for Payer: Multiplan All |
$3,741.01
|
| Rate for Payer: OMNI Networks Commercial |
$2,877.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,699.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,905.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,083.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,823.23
|
| Rate for Payer: Zelis Auto |
$1,644.40
|
|
|
IMPLT ZPTIGHT ANKL SYNDESMOSIS
|
Facility
|
OP
|
$4,111.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,027.75 |
| Max. Negotiated Rate |
$3,905.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,466.60
|
| Rate for Payer: Cash Price |
$2,466.60
|
| Rate for Payer: Cash Price |
$2,466.60
|
| Rate for Payer: Cigna Commercial |
$3,494.35
|
| Rate for Payer: First Health Commercial |
$3,699.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,699.90
|
| Rate for Payer: GEHA Commercial |
$3,288.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,699.90
|
| Rate for Payer: Humana ChoiceCare |
$1,068.86
|
| Rate for Payer: Multiplan All |
$3,741.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,466.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,877.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,699.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,905.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,083.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,617.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,027.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,823.23
|
| Rate for Payer: Zelis Auto |
$1,644.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,055.50
|
|
