|
IMPLT PLATE OLECRANON 7 HOLE LEFT
|
Facility
|
OP
|
$4,019.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.75 |
| Max. Negotiated Rate |
$3,818.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,411.40
|
| Rate for Payer: Cash Price |
$2,411.40
|
| Rate for Payer: Cash Price |
$2,411.40
|
| Rate for Payer: Cigna Commercial |
$3,416.15
|
| Rate for Payer: First Health Commercial |
$3,617.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,617.10
|
| Rate for Payer: GEHA Commercial |
$3,215.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,617.10
|
| Rate for Payer: Humana ChoiceCare |
$1,044.94
|
| Rate for Payer: Multiplan All |
$3,657.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,411.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,813.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,617.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,818.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,014.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,536.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,004.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,737.67
|
| Rate for Payer: Zelis Auto |
$1,607.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,009.50
|
|
|
IMPLT PLATE OLECRANON 7 HOLE LEFT
|
Facility
|
IP
|
$4,019.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,607.60 |
| Max. Negotiated Rate |
$3,818.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,215.20
|
| Rate for Payer: Cash Price |
$2,411.40
|
| Rate for Payer: Cash Price |
$2,411.40
|
| Rate for Payer: Cigna Commercial |
$3,416.15
|
| Rate for Payer: First Health Commercial |
$3,617.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,617.10
|
| Rate for Payer: GEHA Commercial |
$2,813.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,617.10
|
| Rate for Payer: Multiplan All |
$3,657.29
|
| Rate for Payer: OMNI Networks Commercial |
$2,813.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,617.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,818.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,014.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,737.67
|
| Rate for Payer: Zelis Auto |
$1,607.60
|
|
|
IMPLT PLATE OLECRANON 8 HOLE 107MM
|
Facility
|
IP
|
$4,075.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,630.00 |
| Max. Negotiated Rate |
$3,871.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,260.00
|
| Rate for Payer: Cash Price |
$2,445.00
|
| Rate for Payer: Cash Price |
$2,445.00
|
| Rate for Payer: Cigna Commercial |
$3,463.75
|
| Rate for Payer: First Health Commercial |
$3,667.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,667.50
|
| Rate for Payer: GEHA Commercial |
$2,852.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,667.50
|
| Rate for Payer: Multiplan All |
$3,708.25
|
| Rate for Payer: OMNI Networks Commercial |
$2,852.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,667.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,871.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,056.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,789.75
|
| Rate for Payer: Zelis Auto |
$1,630.00
|
|
|
IMPLT PLATE OLECRANON 8 HOLE 107MM
|
Facility
|
OP
|
$4,075.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.75 |
| Max. Negotiated Rate |
$3,871.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,445.00
|
| Rate for Payer: Cash Price |
$2,445.00
|
| Rate for Payer: Cash Price |
$2,445.00
|
| Rate for Payer: Cigna Commercial |
$3,463.75
|
| Rate for Payer: First Health Commercial |
$3,667.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,667.50
|
| Rate for Payer: GEHA Commercial |
$3,260.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,667.50
|
| Rate for Payer: Humana ChoiceCare |
$1,059.50
|
| Rate for Payer: Multiplan All |
$3,708.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,445.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,852.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,667.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,871.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,056.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,586.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,018.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,789.75
|
| Rate for Payer: Zelis Auto |
$1,630.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,037.50
|
|
|
IMPLT PLATE OPEN WEDGE OSTEOTOMY
|
Facility
|
OP
|
$5,037.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.25 |
| Max. Negotiated Rate |
$4,785.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,022.20
|
| Rate for Payer: Cash Price |
$3,022.20
|
| Rate for Payer: Cash Price |
$3,022.20
|
| Rate for Payer: Cigna Commercial |
$4,281.45
|
| Rate for Payer: First Health Commercial |
$4,533.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,533.30
|
| Rate for Payer: GEHA Commercial |
$4,029.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,533.30
|
| Rate for Payer: Humana ChoiceCare |
$1,309.62
|
| Rate for Payer: Multiplan All |
$4,583.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,022.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,525.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,533.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,785.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,777.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,432.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,259.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,684.41
|
| Rate for Payer: Zelis Auto |
$2,014.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,518.50
|
|
|
IMPLT PLATE OPEN WEDGE OSTEOTOMY
|
Facility
|
IP
|
$5,037.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,014.80 |
| Max. Negotiated Rate |
$4,785.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,029.60
|
| Rate for Payer: Cash Price |
$3,022.20
|
| Rate for Payer: Cash Price |
$3,022.20
|
| Rate for Payer: Cigna Commercial |
$4,281.45
|
| Rate for Payer: First Health Commercial |
$4,533.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,533.30
|
| Rate for Payer: GEHA Commercial |
$3,525.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,533.30
|
| Rate for Payer: Multiplan All |
$4,583.67
|
| Rate for Payer: OMNI Networks Commercial |
$3,525.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,533.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,785.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,777.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,684.41
|
| Rate for Payer: Zelis Auto |
$2,014.80
|
|
|
IMPLT PLATE OPEN WEDGE OSTEOTOMY
|
Facility
|
IP
|
$5,037.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,014.80 |
| Max. Negotiated Rate |
$4,785.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,029.60
|
| Rate for Payer: Cash Price |
$3,022.20
|
| Rate for Payer: Cash Price |
$3,022.20
|
| Rate for Payer: Cigna Commercial |
$4,281.45
|
| Rate for Payer: First Health Commercial |
$4,533.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,533.30
|
| Rate for Payer: GEHA Commercial |
$3,525.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,533.30
|
| Rate for Payer: Multiplan All |
$4,583.67
|
| Rate for Payer: OMNI Networks Commercial |
$3,525.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,533.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,785.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,777.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,684.41
|
| Rate for Payer: Zelis Auto |
$2,014.80
|
|
|
IMPLT PLATE OPEN WEDGE OSTEOTOMY
|
Facility
|
OP
|
$5,037.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.25 |
| Max. Negotiated Rate |
$4,785.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,022.20
|
| Rate for Payer: Cash Price |
$3,022.20
|
| Rate for Payer: Cash Price |
$3,022.20
|
| Rate for Payer: Cigna Commercial |
$4,281.45
|
| Rate for Payer: First Health Commercial |
$4,533.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,533.30
|
| Rate for Payer: GEHA Commercial |
$4,029.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,533.30
|
| Rate for Payer: Humana ChoiceCare |
$1,309.62
|
| Rate for Payer: Multiplan All |
$4,583.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,022.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,525.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,533.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,785.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,777.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,432.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,259.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,684.41
|
| Rate for Payer: Zelis Auto |
$2,014.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,518.50
|
|
|
IMPLT PLATE OPEN WEDGE OSTEOTOMY
|
Facility
|
IP
|
$3,937.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,574.80 |
| Max. Negotiated Rate |
$3,740.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,149.60
|
| Rate for Payer: Cash Price |
$2,362.20
|
| Rate for Payer: Cash Price |
$2,362.20
|
| Rate for Payer: Cigna Commercial |
$3,346.45
|
| Rate for Payer: First Health Commercial |
$3,543.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,543.30
|
| Rate for Payer: GEHA Commercial |
$2,755.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,543.30
|
| Rate for Payer: Multiplan All |
$3,582.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,755.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,543.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,740.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,952.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,661.41
|
| Rate for Payer: Zelis Auto |
$1,574.80
|
|
|
IMPLT PLATE OPEN WEDGE OSTEOTOMY
|
Facility
|
OP
|
$3,937.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.25 |
| Max. Negotiated Rate |
$3,740.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,362.20
|
| Rate for Payer: Cash Price |
$2,362.20
|
| Rate for Payer: Cash Price |
$2,362.20
|
| Rate for Payer: Cigna Commercial |
$3,346.45
|
| Rate for Payer: First Health Commercial |
$3,543.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,543.30
|
| Rate for Payer: GEHA Commercial |
$3,149.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,543.30
|
| Rate for Payer: Humana ChoiceCare |
$1,023.62
|
| Rate for Payer: Multiplan All |
$3,582.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,362.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,755.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,543.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,740.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,952.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,464.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$984.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,661.41
|
| Rate for Payer: Zelis Auto |
$1,574.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,968.50
|
|
|
IMPLT PLATE OSTEOTOMY FEMORAL LEFT L/XL
|
Facility
|
OP
|
$5,658.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.50 |
| Max. Negotiated Rate |
$5,375.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,394.80
|
| Rate for Payer: Cash Price |
$3,394.80
|
| Rate for Payer: Cash Price |
$3,394.80
|
| Rate for Payer: Cigna Commercial |
$4,809.30
|
| Rate for Payer: First Health Commercial |
$5,092.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,092.20
|
| Rate for Payer: GEHA Commercial |
$4,526.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,092.20
|
| Rate for Payer: Humana ChoiceCare |
$1,471.08
|
| Rate for Payer: Multiplan All |
$5,148.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,394.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,960.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,092.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,375.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,243.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,979.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,414.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,261.94
|
| Rate for Payer: Zelis Auto |
$2,263.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,829.00
|
|
|
IMPLT PLATE OSTEOTOMY FEMORAL LEFT L/XL
|
Facility
|
IP
|
$5,658.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.20 |
| Max. Negotiated Rate |
$5,375.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,526.40
|
| Rate for Payer: Cash Price |
$3,394.80
|
| Rate for Payer: Cash Price |
$3,394.80
|
| Rate for Payer: Cigna Commercial |
$4,809.30
|
| Rate for Payer: First Health Commercial |
$5,092.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,092.20
|
| Rate for Payer: GEHA Commercial |
$3,960.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,092.20
|
| Rate for Payer: Multiplan All |
$5,148.78
|
| Rate for Payer: OMNI Networks Commercial |
$3,960.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,092.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,375.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,243.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,261.94
|
| Rate for Payer: Zelis Auto |
$2,263.20
|
|
|
IMPLT PLATE OSTEOTOMY FEMORAL LEFT S/M
|
Facility
|
IP
|
$5,658.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.20 |
| Max. Negotiated Rate |
$5,375.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,526.40
|
| Rate for Payer: Cash Price |
$3,394.80
|
| Rate for Payer: Cash Price |
$3,394.80
|
| Rate for Payer: Cigna Commercial |
$4,809.30
|
| Rate for Payer: First Health Commercial |
$5,092.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,092.20
|
| Rate for Payer: GEHA Commercial |
$3,960.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,092.20
|
| Rate for Payer: Multiplan All |
$5,148.78
|
| Rate for Payer: OMNI Networks Commercial |
$3,960.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,092.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,375.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,243.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,261.94
|
| Rate for Payer: Zelis Auto |
$2,263.20
|
|
|
IMPLT PLATE OSTEOTOMY FEMORAL LEFT S/M
|
Facility
|
OP
|
$5,658.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.50 |
| Max. Negotiated Rate |
$5,375.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,394.80
|
| Rate for Payer: Cash Price |
$3,394.80
|
| Rate for Payer: Cash Price |
$3,394.80
|
| Rate for Payer: Cigna Commercial |
$4,809.30
|
| Rate for Payer: First Health Commercial |
$5,092.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,092.20
|
| Rate for Payer: GEHA Commercial |
$4,526.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,092.20
|
| Rate for Payer: Humana ChoiceCare |
$1,471.08
|
| Rate for Payer: Multiplan All |
$5,148.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,394.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,960.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,092.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,375.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,243.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,979.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,414.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,261.94
|
| Rate for Payer: Zelis Auto |
$2,263.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,829.00
|
|
|
IMPLT PLATE PERILOC 4HOLE
|
Facility
|
OP
|
$1,183.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.75 |
| Max. Negotiated Rate |
$1,123.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$709.80
|
| Rate for Payer: Cash Price |
$709.80
|
| Rate for Payer: Cash Price |
$709.80
|
| Rate for Payer: Cigna Commercial |
$1,005.55
|
| Rate for Payer: First Health Commercial |
$1,064.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,064.70
|
| Rate for Payer: GEHA Commercial |
$946.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,064.70
|
| Rate for Payer: Humana ChoiceCare |
$307.58
|
| Rate for Payer: Multiplan All |
$1,076.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$709.80
|
| Rate for Payer: OMNI Networks Commercial |
$828.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,064.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,123.85
|
| Rate for Payer: Three Rivers Provider Network All |
$887.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,041.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$295.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,100.19
|
| Rate for Payer: Zelis Auto |
$473.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$591.50
|
|
|
IMPLT PLATE PERILOC 4HOLE
|
Facility
|
IP
|
$1,183.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$473.20 |
| Max. Negotiated Rate |
$1,123.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$946.40
|
| Rate for Payer: Cash Price |
$709.80
|
| Rate for Payer: Cash Price |
$709.80
|
| Rate for Payer: Cigna Commercial |
$1,005.55
|
| Rate for Payer: First Health Commercial |
$1,064.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,064.70
|
| Rate for Payer: GEHA Commercial |
$828.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,064.70
|
| Rate for Payer: Multiplan All |
$1,076.53
|
| Rate for Payer: OMNI Networks Commercial |
$828.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,064.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,123.85
|
| Rate for Payer: Three Rivers Provider Network All |
$887.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,100.19
|
| Rate for Payer: Zelis Auto |
$473.20
|
|
|
IMPLT PLATE PLANTARPOWER LAPIPLASTY
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,600.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cigna Commercial |
$5,100.00
|
| Rate for Payer: First Health Commercial |
$5,400.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,400.00
|
| Rate for Payer: GEHA Commercial |
$4,800.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,400.00
|
| Rate for Payer: Humana ChoiceCare |
$1,560.00
|
| Rate for Payer: Multiplan All |
$5,460.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,600.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,200.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,400.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,700.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,500.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,280.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,500.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,580.00
|
| Rate for Payer: Zelis Auto |
$2,400.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,000.00
|
|
|
IMPLT PLATE PLANTARPOWER LAPIPLASTY
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,400.00 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,800.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Cigna Commercial |
$5,100.00
|
| Rate for Payer: First Health Commercial |
$5,400.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,400.00
|
| Rate for Payer: GEHA Commercial |
$4,200.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,400.00
|
| Rate for Payer: Multiplan All |
$5,460.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,200.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,400.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,700.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,500.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,580.00
|
| Rate for Payer: Zelis Auto |
$2,400.00
|
|
|
IMPLT PLATE P-L-D HUM LK 80MM
|
Facility
|
IP
|
$3,362.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001208
|
|
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 P-L-D HUM LK 80MM
|
Facility
|
OP
|
$3,362.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001208
|
|
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 PROXIMAL HUMERUS
|
Facility
|
IP
|
$3,851.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.40 |
| Max. Negotiated Rate |
$3,658.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,080.80
|
| Rate for Payer: Cash Price |
$2,310.60
|
| Rate for Payer: Cash Price |
$2,310.60
|
| Rate for Payer: Cigna Commercial |
$3,273.35
|
| Rate for Payer: First Health Commercial |
$3,465.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,465.90
|
| Rate for Payer: GEHA Commercial |
$2,695.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,465.90
|
| Rate for Payer: Multiplan All |
$3,504.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,695.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,465.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,658.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,888.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,581.43
|
| Rate for Payer: Zelis Auto |
$1,540.40
|
|
|
IMPLT PLATE PROXIMAL HUMERUS
|
Facility
|
OP
|
$3,851.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$962.75 |
| Max. Negotiated Rate |
$3,658.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,310.60
|
| Rate for Payer: Cash Price |
$2,310.60
|
| Rate for Payer: Cash Price |
$2,310.60
|
| Rate for Payer: Cigna Commercial |
$3,273.35
|
| Rate for Payer: First Health Commercial |
$3,465.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,465.90
|
| Rate for Payer: GEHA Commercial |
$3,080.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,465.90
|
| Rate for Payer: Humana ChoiceCare |
$1,001.26
|
| Rate for Payer: Multiplan All |
$3,504.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,310.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,695.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,465.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,658.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,888.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,388.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$962.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,581.43
|
| Rate for Payer: Zelis Auto |
$1,540.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,925.50
|
|
|
IMPLT PLATE PROXIMAL RIGHT HOLE 3
|
Facility
|
OP
|
$6,637.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.25 |
| Max. Negotiated Rate |
$6,305.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,982.20
|
| Rate for Payer: Cash Price |
$3,982.20
|
| Rate for Payer: Cash Price |
$3,982.20
|
| Rate for Payer: Cigna Commercial |
$5,641.45
|
| Rate for Payer: First Health Commercial |
$5,973.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,973.30
|
| Rate for Payer: GEHA Commercial |
$5,309.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,973.30
|
| Rate for Payer: Humana ChoiceCare |
$1,725.62
|
| Rate for Payer: Multiplan All |
$6,039.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,982.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,645.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,973.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,305.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,977.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,840.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,659.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,172.41
|
| Rate for Payer: Zelis Auto |
$2,654.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,318.50
|
|
|
IMPLT PLATE PROXIMAL RIGHT HOLE 3
|
Facility
|
IP
|
$6,637.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,654.80 |
| Max. Negotiated Rate |
$6,305.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,309.60
|
| Rate for Payer: Cash Price |
$3,982.20
|
| Rate for Payer: Cash Price |
$3,982.20
|
| Rate for Payer: Cigna Commercial |
$5,641.45
|
| Rate for Payer: First Health Commercial |
$5,973.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,973.30
|
| Rate for Payer: GEHA Commercial |
$4,645.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,973.30
|
| Rate for Payer: Multiplan All |
$6,039.67
|
| Rate for Payer: OMNI Networks Commercial |
$4,645.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,973.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,305.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,977.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,172.41
|
| Rate for Payer: Zelis Auto |
$2,654.80
|
|
|
IMPLT PLATE RADIUS DISTAL LEFT
|
Facility
|
IP
|
$3,505.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.00 |
| Max. Negotiated Rate |
$3,329.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,804.00
|
| Rate for Payer: Cash Price |
$2,103.00
|
| Rate for Payer: Cash Price |
$2,103.00
|
| Rate for Payer: Cigna Commercial |
$2,979.25
|
| Rate for Payer: First Health Commercial |
$3,154.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,154.50
|
| Rate for Payer: GEHA Commercial |
$2,453.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,154.50
|
| Rate for Payer: Multiplan All |
$3,189.55
|
| Rate for Payer: OMNI Networks Commercial |
$2,453.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,154.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,329.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,628.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,259.65
|
| Rate for Payer: Zelis Auto |
$1,402.00
|
|
