|
IMPLT PLATE HUMERUS PROX 12-HOLE
|
Facility
|
OP
|
$6,653.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,663.25 |
| Max. Negotiated Rate |
$6,320.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,991.80
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$5,655.05
|
| Rate for Payer: First Health Commercial |
$5,987.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,987.70
|
| Rate for Payer: GEHA Commercial |
$5,322.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,987.70
|
| Rate for Payer: Humana ChoiceCare |
$1,729.78
|
| Rate for Payer: Multiplan All |
$6,054.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,991.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,657.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,987.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,320.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,989.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,854.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,663.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,187.29
|
| Rate for Payer: Zelis Auto |
$2,661.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,326.50
|
|
|
IMPLT PLATE HUMERUS PROX 5-HOLE
|
Facility
|
IP
|
$6,803.46
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,721.38 |
| Max. Negotiated Rate |
$6,463.29 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,442.77
|
| Rate for Payer: Cash Price |
$4,082.08
|
| Rate for Payer: Cash Price |
$4,082.08
|
| Rate for Payer: Cigna Commercial |
$5,782.94
|
| Rate for Payer: First Health Commercial |
$6,123.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,123.11
|
| Rate for Payer: GEHA Commercial |
$4,762.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,123.11
|
| Rate for Payer: Multiplan All |
$6,191.15
|
| Rate for Payer: OMNI Networks Commercial |
$4,762.42
|
| Rate for Payer: One Health Plan PPO/POS |
$6,123.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,463.29
|
| Rate for Payer: Three Rivers Provider Network All |
$5,102.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,327.22
|
| Rate for Payer: Zelis Auto |
$2,721.38
|
|
|
IMPLT PLATE HUMERUS PROX 5-HOLE
|
Facility
|
OP
|
$6,803.46
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,700.87 |
| Max. Negotiated Rate |
$6,463.29 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,082.08
|
| Rate for Payer: Cash Price |
$4,082.08
|
| Rate for Payer: Cash Price |
$4,082.08
|
| Rate for Payer: Cigna Commercial |
$5,782.94
|
| Rate for Payer: First Health Commercial |
$6,123.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,123.11
|
| Rate for Payer: GEHA Commercial |
$5,442.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,123.11
|
| Rate for Payer: Humana ChoiceCare |
$1,768.90
|
| Rate for Payer: Multiplan All |
$6,191.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,082.08
|
| Rate for Payer: OMNI Networks Commercial |
$4,762.42
|
| Rate for Payer: One Health Plan PPO/POS |
$6,123.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,463.29
|
| Rate for Payer: Three Rivers Provider Network All |
$5,102.60
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,987.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,700.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,327.22
|
| Rate for Payer: Zelis Auto |
$2,721.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,401.73
|
|
|
IMPLT PLATE HUMERUS PROX 5-HOLE
|
Facility
|
OP
|
$6,803.46
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,700.87 |
| Max. Negotiated Rate |
$6,463.29 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,082.08
|
| Rate for Payer: Cash Price |
$4,082.08
|
| Rate for Payer: Cash Price |
$4,082.08
|
| Rate for Payer: Cigna Commercial |
$5,782.94
|
| Rate for Payer: First Health Commercial |
$6,123.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,123.11
|
| Rate for Payer: GEHA Commercial |
$5,442.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,123.11
|
| Rate for Payer: Humana ChoiceCare |
$1,768.90
|
| Rate for Payer: Multiplan All |
$6,191.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,082.08
|
| Rate for Payer: OMNI Networks Commercial |
$4,762.42
|
| Rate for Payer: One Health Plan PPO/POS |
$6,123.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,463.29
|
| Rate for Payer: Three Rivers Provider Network All |
$5,102.60
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,987.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,700.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,327.22
|
| Rate for Payer: Zelis Auto |
$2,721.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,401.73
|
|
|
IMPLT PLATE HUMERUS PROX 5-HOLE
|
Facility
|
IP
|
$6,803.46
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,721.38 |
| Max. Negotiated Rate |
$6,463.29 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,442.77
|
| Rate for Payer: Cash Price |
$4,082.08
|
| Rate for Payer: Cash Price |
$4,082.08
|
| Rate for Payer: Cigna Commercial |
$5,782.94
|
| Rate for Payer: First Health Commercial |
$6,123.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,123.11
|
| Rate for Payer: GEHA Commercial |
$4,762.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,123.11
|
| Rate for Payer: Multiplan All |
$6,191.15
|
| Rate for Payer: OMNI Networks Commercial |
$4,762.42
|
| Rate for Payer: One Health Plan PPO/POS |
$6,123.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,463.29
|
| Rate for Payer: Three Rivers Provider Network All |
$5,102.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,327.22
|
| Rate for Payer: Zelis Auto |
$2,721.38
|
|
|
IMPLT PLATE HUMERUS PROX 7-HOLE
|
Facility
|
OP
|
$4,906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.50 |
| Max. Negotiated Rate |
$4,660.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,943.60
|
| Rate for Payer: Cash Price |
$2,943.60
|
| Rate for Payer: Cash Price |
$2,943.60
|
| Rate for Payer: Cigna Commercial |
$4,170.10
|
| Rate for Payer: First Health Commercial |
$4,415.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,415.40
|
| Rate for Payer: GEHA Commercial |
$3,924.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,415.40
|
| Rate for Payer: Humana ChoiceCare |
$1,275.56
|
| Rate for Payer: Multiplan All |
$4,464.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,943.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,434.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,415.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,660.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,317.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,562.58
|
| Rate for Payer: Zelis Auto |
$1,962.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,453.00
|
|
|
IMPLT PLATE HUMERUS PROX 7-HOLE
|
Facility
|
IP
|
$4,906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,962.40 |
| Max. Negotiated Rate |
$4,660.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,924.80
|
| Rate for Payer: Cash Price |
$2,943.60
|
| Rate for Payer: Cash Price |
$2,943.60
|
| Rate for Payer: Cigna Commercial |
$4,170.10
|
| Rate for Payer: First Health Commercial |
$4,415.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,415.40
|
| Rate for Payer: GEHA Commercial |
$3,434.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,415.40
|
| Rate for Payer: Multiplan All |
$4,464.46
|
| Rate for Payer: OMNI Networks Commercial |
$3,434.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,415.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,660.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,562.58
|
| Rate for Payer: Zelis Auto |
$1,962.40
|
|
|
IMPLT PLATE HUMERUS PROX HOLE-3
|
Facility
|
OP
|
$7,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,918.75 |
| Max. Negotiated Rate |
$7,291.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,605.00
|
| Rate for Payer: Cash Price |
$4,605.00
|
| Rate for Payer: Cash Price |
$4,605.00
|
| Rate for Payer: Cigna Commercial |
$6,523.75
|
| Rate for Payer: First Health Commercial |
$6,907.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,907.50
|
| Rate for Payer: GEHA Commercial |
$6,140.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,907.50
|
| Rate for Payer: Humana ChoiceCare |
$1,995.50
|
| Rate for Payer: Multiplan All |
$6,984.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,605.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,372.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,907.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,291.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,756.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,754.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,918.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,137.75
|
| Rate for Payer: Zelis Auto |
$3,070.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,837.50
|
|
|
IMPLT PLATE HUMERUS PROX HOLE-3
|
Facility
|
IP
|
$7,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,070.00 |
| Max. Negotiated Rate |
$7,291.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,140.00
|
| Rate for Payer: Cash Price |
$4,605.00
|
| Rate for Payer: Cash Price |
$4,605.00
|
| Rate for Payer: Cigna Commercial |
$6,523.75
|
| Rate for Payer: First Health Commercial |
$6,907.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,907.50
|
| Rate for Payer: GEHA Commercial |
$5,372.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,907.50
|
| Rate for Payer: Multiplan All |
$6,984.25
|
| Rate for Payer: OMNI Networks Commercial |
$5,372.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,907.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,291.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,756.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,137.75
|
| Rate for Payer: Zelis Auto |
$3,070.00
|
|
|
IMPLT PLATE HUMERUS PROXIMAL 3.5MM
|
Facility
|
OP
|
$6,238.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.50 |
| Max. Negotiated Rate |
$5,926.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,742.80
|
| Rate for Payer: Cash Price |
$3,742.80
|
| Rate for Payer: Cash Price |
$3,742.80
|
| Rate for Payer: Cigna Commercial |
$5,302.30
|
| Rate for Payer: First Health Commercial |
$5,614.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,614.20
|
| Rate for Payer: GEHA Commercial |
$4,990.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,614.20
|
| Rate for Payer: Humana ChoiceCare |
$1,621.88
|
| Rate for Payer: Multiplan All |
$5,676.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,742.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,366.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,614.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,926.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,678.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,489.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,559.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,801.34
|
| Rate for Payer: Zelis Auto |
$2,495.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,119.00
|
|
|
IMPLT PLATE HUMERUS PROXIMAL 3.5MM
|
Facility
|
IP
|
$6,238.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$5,926.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,990.40
|
| Rate for Payer: Cash Price |
$3,742.80
|
| Rate for Payer: Cash Price |
$3,742.80
|
| Rate for Payer: Cigna Commercial |
$5,302.30
|
| Rate for Payer: First Health Commercial |
$5,614.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,614.20
|
| Rate for Payer: GEHA Commercial |
$4,366.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,614.20
|
| Rate for Payer: Multiplan All |
$5,676.58
|
| Rate for Payer: OMNI Networks Commercial |
$4,366.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,614.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,926.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,678.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,801.34
|
| Rate for Payer: Zelis Auto |
$2,495.20
|
|
|
IMPLT PLATE HUM LK PL 5H L 80MM
|
Facility
|
IP
|
$3,362.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,344.80 |
| Max. Negotiated Rate |
$3,193.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,689.60
|
| Rate for Payer: Cash Price |
$2,017.20
|
| Rate for Payer: Cash Price |
$2,017.20
|
| Rate for Payer: Cigna Commercial |
$2,857.70
|
| Rate for Payer: First Health Commercial |
$3,025.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,025.80
|
| Rate for Payer: GEHA Commercial |
$2,353.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,025.80
|
| Rate for Payer: Multiplan All |
$3,059.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,353.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,025.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,193.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,521.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,126.66
|
| Rate for Payer: Zelis Auto |
$1,344.80
|
|
|
IMPLT PLATE HUM LK PL 5H L 80MM
|
Facility
|
OP
|
$3,362.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.50 |
| Max. Negotiated Rate |
$3,193.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,017.20
|
| Rate for Payer: Cash Price |
$2,017.20
|
| Rate for Payer: Cash Price |
$2,017.20
|
| Rate for Payer: Cigna Commercial |
$2,857.70
|
| Rate for Payer: First Health Commercial |
$3,025.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,025.80
|
| Rate for Payer: GEHA Commercial |
$2,689.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,025.80
|
| Rate for Payer: Humana ChoiceCare |
$874.12
|
| Rate for Payer: Multiplan All |
$3,059.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,017.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,353.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,025.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,193.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,521.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$840.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,126.66
|
| Rate for Payer: Zelis Auto |
$1,344.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,681.00
|
|
|
IMPLT PLATE INSULATES 9IN BLUE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$88.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Humana ChoiceCare |
$28.60
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$66.00
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$96.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$55.00
|
|
|
IMPLT PLATE INSULATES 9IN BLUE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$88.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$77.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
|
|
IMPLT PLATE LATERAL PROXIMAL 2-HOLE
|
Facility
|
OP
|
$6,601.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.25 |
| Max. Negotiated Rate |
$6,270.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,960.60
|
| Rate for Payer: Cash Price |
$3,960.60
|
| Rate for Payer: Cash Price |
$3,960.60
|
| Rate for Payer: Cigna Commercial |
$5,610.85
|
| Rate for Payer: First Health Commercial |
$5,940.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,940.90
|
| Rate for Payer: GEHA Commercial |
$5,280.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,940.90
|
| Rate for Payer: Humana ChoiceCare |
$1,716.26
|
| Rate for Payer: Multiplan All |
$6,006.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,960.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,620.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,940.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,270.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,950.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,808.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,650.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,138.93
|
| Rate for Payer: Zelis Auto |
$2,640.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,300.50
|
|
|
IMPLT PLATE LATERAL PROXIMAL 2-HOLE
|
Facility
|
IP
|
$6,601.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.40 |
| Max. Negotiated Rate |
$6,270.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,280.80
|
| Rate for Payer: Cash Price |
$3,960.60
|
| Rate for Payer: Cash Price |
$3,960.60
|
| Rate for Payer: Cigna Commercial |
$5,610.85
|
| Rate for Payer: First Health Commercial |
$5,940.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,940.90
|
| Rate for Payer: GEHA Commercial |
$4,620.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,940.90
|
| Rate for Payer: Multiplan All |
$6,006.91
|
| Rate for Payer: OMNI Networks Commercial |
$4,620.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,940.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,270.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,950.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,138.93
|
| Rate for Payer: Zelis Auto |
$2,640.40
|
|
|
IMPLT PLATE LATERAL PROXIMAL 8-HL 173MM
|
Facility
|
OP
|
$6,775.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,693.75 |
| Max. Negotiated Rate |
$6,436.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,065.00
|
| Rate for Payer: Cash Price |
$4,065.00
|
| Rate for Payer: Cash Price |
$4,065.00
|
| Rate for Payer: Cigna Commercial |
$5,758.75
|
| Rate for Payer: First Health Commercial |
$6,097.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,097.50
|
| Rate for Payer: GEHA Commercial |
$5,420.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,097.50
|
| Rate for Payer: Humana ChoiceCare |
$1,761.50
|
| Rate for Payer: Multiplan All |
$6,165.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,065.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,742.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,097.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,436.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,081.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,962.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,693.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,300.75
|
| Rate for Payer: Zelis Auto |
$2,710.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,387.50
|
|
|
IMPLT PLATE LATERAL PROXIMAL 8-HL 173MM
|
Facility
|
IP
|
$6,775.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,710.00 |
| Max. Negotiated Rate |
$6,436.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,420.00
|
| Rate for Payer: Cash Price |
$4,065.00
|
| Rate for Payer: Cash Price |
$4,065.00
|
| Rate for Payer: Cigna Commercial |
$5,758.75
|
| Rate for Payer: First Health Commercial |
$6,097.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,097.50
|
| Rate for Payer: GEHA Commercial |
$4,742.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,097.50
|
| Rate for Payer: Multiplan All |
$6,165.25
|
| Rate for Payer: OMNI Networks Commercial |
$4,742.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,097.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,436.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,081.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,300.75
|
| Rate for Payer: Zelis Auto |
$2,710.00
|
|
|
IMPLT PLATE LCP 10 HOLE 3.5X137MM
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.75 |
| Max. Negotiated Rate |
$1,108.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cigna Commercial |
$991.95
|
| Rate for Payer: First Health Commercial |
$1,050.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,050.30
|
| Rate for Payer: GEHA Commercial |
$933.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,050.30
|
| Rate for Payer: Humana ChoiceCare |
$303.42
|
| Rate for Payer: Multiplan All |
$1,061.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$700.20
|
| Rate for Payer: OMNI Networks Commercial |
$816.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,050.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,108.65
|
| Rate for Payer: Three Rivers Provider Network All |
$875.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,026.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$291.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,085.31
|
| Rate for Payer: Zelis Auto |
$466.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$583.50
|
|
|
IMPLT PLATE LCP 10 HOLE 3.5X137MM
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.80 |
| Max. Negotiated Rate |
$1,108.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$933.60
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cigna Commercial |
$991.95
|
| Rate for Payer: First Health Commercial |
$1,050.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,050.30
|
| Rate for Payer: GEHA Commercial |
$816.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,050.30
|
| Rate for Payer: Multiplan All |
$1,061.97
|
| Rate for Payer: OMNI Networks Commercial |
$816.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,050.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,108.65
|
| Rate for Payer: Three Rivers Provider Network All |
$875.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,085.31
|
| Rate for Payer: Zelis Auto |
$466.80
|
|
|
IMPLT PLATE LCP 3.5X84MM 6 HOLE
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001188
|
|
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 PLATE LCP 3.5X84MM 6 HOLE
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001188
|
|
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 PLATE LCP 5 HOLE 3.5X72MM
|
Facility
|
IP
|
$2,235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.00 |
| Max. Negotiated Rate |
$2,123.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,788.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$1,899.75
|
| Rate for Payer: First Health Commercial |
$2,011.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,011.50
|
| Rate for Payer: GEHA Commercial |
$1,564.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,011.50
|
| Rate for Payer: Multiplan All |
$2,033.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,564.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,011.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,123.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,676.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,078.55
|
| Rate for Payer: Zelis Auto |
$894.00
|
|
|
IMPLT PLATE LCP 5 HOLE 3.5X72MM
|
Facility
|
OP
|
$2,235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.75 |
| Max. Negotiated Rate |
$2,123.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$1,899.75
|
| Rate for Payer: First Health Commercial |
$2,011.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,011.50
|
| Rate for Payer: GEHA Commercial |
$1,788.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,011.50
|
| Rate for Payer: Humana ChoiceCare |
$581.10
|
| Rate for Payer: Multiplan All |
$2,033.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,341.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,564.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,011.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,123.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,676.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,966.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$558.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,078.55
|
| Rate for Payer: Zelis Auto |
$894.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,117.50
|
|
