|
IMPLT PLATE TIBIAL LOCKING 3.5X123MM
|
Facility
|
OP
|
$5,310.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,327.50 |
| Max. Negotiated Rate |
$5,044.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,186.00
|
| Rate for Payer: Cash Price |
$3,186.00
|
| Rate for Payer: Cash Price |
$3,186.00
|
| Rate for Payer: Cigna Commercial |
$4,513.50
|
| Rate for Payer: First Health Commercial |
$4,779.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,779.00
|
| Rate for Payer: GEHA Commercial |
$4,248.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,779.00
|
| Rate for Payer: Humana ChoiceCare |
$1,380.60
|
| Rate for Payer: Multiplan All |
$4,832.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,186.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,717.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,779.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,044.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,982.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,672.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,327.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,938.30
|
| Rate for Payer: Zelis Auto |
$2,124.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,655.00
|
|
|
IMPLT PLATE TIBIAL LOCKING 3.5X173MM
|
Facility
|
OP
|
$4,466.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.50 |
| Max. Negotiated Rate |
$4,242.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,679.60
|
| Rate for Payer: Cash Price |
$2,679.60
|
| Rate for Payer: Cash Price |
$2,679.60
|
| Rate for Payer: Cigna Commercial |
$3,796.10
|
| Rate for Payer: First Health Commercial |
$4,019.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,019.40
|
| Rate for Payer: GEHA Commercial |
$3,572.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,019.40
|
| Rate for Payer: Humana ChoiceCare |
$1,161.16
|
| Rate for Payer: Multiplan All |
$4,064.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,679.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,126.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,019.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,242.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,349.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,930.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,116.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,153.38
|
| Rate for Payer: Zelis Auto |
$1,786.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,233.00
|
|
|
IMPLT PLATE TIBIAL LOCKING 3.5X173MM
|
Facility
|
IP
|
$4,466.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,786.40 |
| Max. Negotiated Rate |
$4,242.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,572.80
|
| Rate for Payer: Cash Price |
$2,679.60
|
| Rate for Payer: Cash Price |
$2,679.60
|
| Rate for Payer: Cigna Commercial |
$3,796.10
|
| Rate for Payer: First Health Commercial |
$4,019.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,019.40
|
| Rate for Payer: GEHA Commercial |
$3,126.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,019.40
|
| Rate for Payer: Multiplan All |
$4,064.06
|
| Rate for Payer: OMNI Networks Commercial |
$3,126.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,019.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,242.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,349.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,153.38
|
| Rate for Payer: Zelis Auto |
$1,786.40
|
|
|
IMPLT PLATE TIBIAL LOCKING 3HOLE
|
Facility
|
OP
|
$5,169.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,292.25 |
| Max. Negotiated Rate |
$4,910.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,101.40
|
| Rate for Payer: Cash Price |
$3,101.40
|
| Rate for Payer: Cash Price |
$3,101.40
|
| Rate for Payer: Cigna Commercial |
$4,393.65
|
| Rate for Payer: First Health Commercial |
$4,652.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,652.10
|
| Rate for Payer: GEHA Commercial |
$4,135.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,652.10
|
| Rate for Payer: Humana ChoiceCare |
$1,343.94
|
| Rate for Payer: Multiplan All |
$4,703.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,101.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,618.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,652.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,910.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,876.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,548.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,292.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,807.17
|
| Rate for Payer: Zelis Auto |
$2,067.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,584.50
|
|
|
IMPLT PLATE TIBIAL LOCKING 3HOLE
|
Facility
|
IP
|
$5,169.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.60 |
| Max. Negotiated Rate |
$4,910.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,135.20
|
| Rate for Payer: Cash Price |
$3,101.40
|
| Rate for Payer: Cash Price |
$3,101.40
|
| Rate for Payer: Cigna Commercial |
$4,393.65
|
| Rate for Payer: First Health Commercial |
$4,652.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,652.10
|
| Rate for Payer: GEHA Commercial |
$3,618.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,652.10
|
| Rate for Payer: Multiplan All |
$4,703.79
|
| Rate for Payer: OMNI Networks Commercial |
$3,618.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,652.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,910.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,876.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,807.17
|
| Rate for Payer: Zelis Auto |
$2,067.60
|
|
|
IMPLT PLATE TIBIAL LOCKING 6 HOLE
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$4,987.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Cigna Commercial |
$4,462.50
|
| Rate for Payer: First Health Commercial |
$4,725.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,725.00
|
| Rate for Payer: GEHA Commercial |
$4,200.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,725.00
|
| Rate for Payer: Humana ChoiceCare |
$1,365.00
|
| Rate for Payer: Multiplan All |
$4,777.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,150.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,675.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,725.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,987.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,937.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,620.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,882.50
|
| Rate for Payer: Zelis Auto |
$2,100.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,625.00
|
|
|
IMPLT PLATE TIBIAL LOCKING 6 HOLE
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$4,987.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,200.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Cigna Commercial |
$4,462.50
|
| Rate for Payer: First Health Commercial |
$4,725.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,725.00
|
| Rate for Payer: GEHA Commercial |
$3,675.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,725.00
|
| Rate for Payer: Multiplan All |
$4,777.50
|
| Rate for Payer: OMNI Networks Commercial |
$3,675.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,725.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,987.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,937.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,882.50
|
| Rate for Payer: Zelis Auto |
$2,100.00
|
|
|
IMPLT PLATE TIBIA LOCKING 3HOLE 3.5
|
Facility
|
IP
|
$5,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,028.00 |
| Max. Negotiated Rate |
$4,816.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,056.00
|
| Rate for Payer: Cash Price |
$3,042.00
|
| Rate for Payer: Cash Price |
$3,042.00
|
| Rate for Payer: Cigna Commercial |
$4,309.50
|
| Rate for Payer: First Health Commercial |
$4,563.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,563.00
|
| Rate for Payer: GEHA Commercial |
$3,549.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,563.00
|
| Rate for Payer: Multiplan All |
$4,613.70
|
| Rate for Payer: OMNI Networks Commercial |
$3,549.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,563.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,816.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,802.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,715.10
|
| Rate for Payer: Zelis Auto |
$2,028.00
|
|
|
IMPLT PLATE TIBIA LOCKING 3HOLE 3.5
|
Facility
|
OP
|
$5,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.50 |
| Max. Negotiated Rate |
$4,816.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,042.00
|
| Rate for Payer: Cash Price |
$3,042.00
|
| Rate for Payer: Cash Price |
$3,042.00
|
| Rate for Payer: Cigna Commercial |
$4,309.50
|
| Rate for Payer: First Health Commercial |
$4,563.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,563.00
|
| Rate for Payer: GEHA Commercial |
$4,056.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,563.00
|
| Rate for Payer: Humana ChoiceCare |
$1,318.20
|
| Rate for Payer: Multiplan All |
$4,613.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,042.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,549.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,563.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,816.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,802.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,461.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,267.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,715.10
|
| Rate for Payer: Zelis Auto |
$2,028.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,535.00
|
|
|
IMPLT PLATE TIBIA LOCKING 4.5MM
|
Facility
|
IP
|
$4,858.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,943.20 |
| Max. Negotiated Rate |
$4,615.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,886.40
|
| Rate for Payer: Cash Price |
$2,914.80
|
| Rate for Payer: Cash Price |
$2,914.80
|
| Rate for Payer: Cigna Commercial |
$4,129.30
|
| Rate for Payer: First Health Commercial |
$4,372.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,372.20
|
| Rate for Payer: GEHA Commercial |
$3,400.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,372.20
|
| Rate for Payer: Multiplan All |
$4,420.78
|
| Rate for Payer: OMNI Networks Commercial |
$3,400.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,372.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,615.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,643.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,517.94
|
| Rate for Payer: Zelis Auto |
$1,943.20
|
|
|
IMPLT PLATE TIBIA LOCKING 4.5MM
|
Facility
|
OP
|
$4,858.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,214.50 |
| Max. Negotiated Rate |
$4,615.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,914.80
|
| Rate for Payer: Cash Price |
$2,914.80
|
| Rate for Payer: Cash Price |
$2,914.80
|
| Rate for Payer: Cigna Commercial |
$4,129.30
|
| Rate for Payer: First Health Commercial |
$4,372.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,372.20
|
| Rate for Payer: GEHA Commercial |
$3,886.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,372.20
|
| Rate for Payer: Humana ChoiceCare |
$1,263.08
|
| Rate for Payer: Multiplan All |
$4,420.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,914.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,400.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,372.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,615.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,643.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,275.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,214.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,517.94
|
| Rate for Payer: Zelis Auto |
$1,943.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,429.00
|
|
|
IMPLT PLATE TIBIA LOCKING 6HOLE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,845.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,060.00
|
| Rate for Payer: Cash Price |
$3,060.00
|
| Rate for Payer: Cash Price |
$3,060.00
|
| Rate for Payer: Cigna Commercial |
$4,335.00
|
| Rate for Payer: First Health Commercial |
$4,590.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,590.00
|
| Rate for Payer: GEHA Commercial |
$4,080.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,590.00
|
| Rate for Payer: Humana ChoiceCare |
$1,326.00
|
| Rate for Payer: Multiplan All |
$4,641.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,060.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,570.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,590.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,845.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,825.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,488.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,275.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,743.00
|
| Rate for Payer: Zelis Auto |
$2,040.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,550.00
|
|
|
IMPLT PLATE TIBIA LOCKING 6HOLE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.00 |
| Max. Negotiated Rate |
$4,845.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,080.00
|
| Rate for Payer: Cash Price |
$3,060.00
|
| Rate for Payer: Cash Price |
$3,060.00
|
| Rate for Payer: Cigna Commercial |
$4,335.00
|
| Rate for Payer: First Health Commercial |
$4,590.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,590.00
|
| Rate for Payer: GEHA Commercial |
$3,570.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,590.00
|
| Rate for Payer: Multiplan All |
$4,641.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,570.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,590.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,845.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,825.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,743.00
|
| Rate for Payer: Zelis Auto |
$2,040.00
|
|
|
IMPLT PLATE TIBIAL OSTEO
|
Facility
|
OP
|
$3,937.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006354
|
|
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 TIBIAL OSTEO
|
Facility
|
IP
|
$3,937.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006354
|
|
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 TIBIAL WEDGE OSTEOTOMY 12.5
|
Facility
|
OP
|
$3,024.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.00 |
| Max. Negotiated Rate |
$2,872.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,814.40
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cigna Commercial |
$2,570.40
|
| Rate for Payer: First Health Commercial |
$2,721.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,721.60
|
| Rate for Payer: GEHA Commercial |
$2,419.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,721.60
|
| Rate for Payer: Humana ChoiceCare |
$786.24
|
| Rate for Payer: Multiplan All |
$2,751.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,814.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,116.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,721.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,872.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,268.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,661.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$756.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,812.32
|
| Rate for Payer: Zelis Auto |
$1,209.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,512.00
|
|
|
IMPLT PLATE TIBIAL WEDGE OSTEOTOMY 12.5
|
Facility
|
IP
|
$3,024.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,209.60 |
| Max. Negotiated Rate |
$2,872.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,419.20
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cigna Commercial |
$2,570.40
|
| Rate for Payer: First Health Commercial |
$2,721.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,721.60
|
| Rate for Payer: GEHA Commercial |
$2,116.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,721.60
|
| Rate for Payer: Multiplan All |
$2,751.84
|
| Rate for Payer: OMNI Networks Commercial |
$2,116.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,721.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,872.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,268.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,812.32
|
| Rate for Payer: Zelis Auto |
$1,209.60
|
|
|
IMPLT PLATE TIBIA PROXIMAL 3.5MM LEFT
|
Facility
|
OP
|
$4,572.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,143.00 |
| Max. Negotiated Rate |
$4,343.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,743.20
|
| Rate for Payer: Cash Price |
$2,743.20
|
| Rate for Payer: Cash Price |
$2,743.20
|
| Rate for Payer: Cigna Commercial |
$3,886.20
|
| Rate for Payer: First Health Commercial |
$4,114.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,114.80
|
| Rate for Payer: GEHA Commercial |
$3,657.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,114.80
|
| Rate for Payer: Humana ChoiceCare |
$1,188.72
|
| Rate for Payer: Multiplan All |
$4,160.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,743.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,200.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,114.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,343.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,429.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,023.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,143.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,251.96
|
| Rate for Payer: Zelis Auto |
$1,828.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,286.00
|
|
|
IMPLT PLATE TIBIA PROXIMAL 3.5MM LEFT
|
Facility
|
IP
|
$4,572.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,828.80 |
| Max. Negotiated Rate |
$4,343.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,657.60
|
| Rate for Payer: Cash Price |
$2,743.20
|
| Rate for Payer: Cash Price |
$2,743.20
|
| Rate for Payer: Cigna Commercial |
$3,886.20
|
| Rate for Payer: First Health Commercial |
$4,114.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,114.80
|
| Rate for Payer: GEHA Commercial |
$3,200.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,114.80
|
| Rate for Payer: Multiplan All |
$4,160.52
|
| Rate for Payer: OMNI Networks Commercial |
$3,200.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,114.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,343.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,429.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,251.96
|
| Rate for Payer: Zelis Auto |
$1,828.80
|
|
|
IMPLT PLATE TIBIA PROXIMAL LATERAL
|
Facility
|
OP
|
$6,911.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$6,565.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,146.60
|
| Rate for Payer: Cash Price |
$4,146.60
|
| Rate for Payer: Cash Price |
$4,146.60
|
| Rate for Payer: Cigna Commercial |
$5,874.35
|
| Rate for Payer: First Health Commercial |
$6,219.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,219.90
|
| Rate for Payer: GEHA Commercial |
$5,528.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,219.90
|
| Rate for Payer: Humana ChoiceCare |
$1,796.86
|
| Rate for Payer: Multiplan All |
$6,289.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,146.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,837.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,219.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,565.45
|
| Rate for Payer: Three Rivers Provider Network All |
$5,183.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,081.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,727.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,427.23
|
| Rate for Payer: Zelis Auto |
$2,764.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,455.50
|
|
|
IMPLT PLATE TIBIA PROXIMAL LATERAL
|
Facility
|
IP
|
$6,911.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.40 |
| Max. Negotiated Rate |
$6,565.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,528.80
|
| Rate for Payer: Cash Price |
$4,146.60
|
| Rate for Payer: Cash Price |
$4,146.60
|
| Rate for Payer: Cigna Commercial |
$5,874.35
|
| Rate for Payer: First Health Commercial |
$6,219.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,219.90
|
| Rate for Payer: GEHA Commercial |
$4,837.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,219.90
|
| Rate for Payer: Multiplan All |
$6,289.01
|
| Rate for Payer: OMNI Networks Commercial |
$4,837.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,219.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,565.45
|
| Rate for Payer: Three Rivers Provider Network All |
$5,183.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,427.23
|
| Rate for Payer: Zelis Auto |
$2,764.40
|
|
|
IMPLT PLATE TIB PROX 6 HL 3 BN RT
|
Facility
|
IP
|
$6,074.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,429.60 |
| Max. Negotiated Rate |
$5,770.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,859.20
|
| Rate for Payer: Cash Price |
$3,644.40
|
| Rate for Payer: Cash Price |
$3,644.40
|
| Rate for Payer: Cigna Commercial |
$5,162.90
|
| Rate for Payer: First Health Commercial |
$5,466.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,466.60
|
| Rate for Payer: GEHA Commercial |
$4,251.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,466.60
|
| Rate for Payer: Multiplan All |
$5,527.34
|
| Rate for Payer: OMNI Networks Commercial |
$4,251.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,466.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,770.30
|
| Rate for Payer: Three Rivers Provider Network All |
$4,555.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,648.82
|
| Rate for Payer: Zelis Auto |
$2,429.60
|
|
|
IMPLT PLATE TIB PROX 6 HL 3 BN RT
|
Facility
|
OP
|
$6,074.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,518.50 |
| Max. Negotiated Rate |
$5,770.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,644.40
|
| Rate for Payer: Cash Price |
$3,644.40
|
| Rate for Payer: Cash Price |
$3,644.40
|
| Rate for Payer: Cigna Commercial |
$5,162.90
|
| Rate for Payer: First Health Commercial |
$5,466.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,466.60
|
| Rate for Payer: GEHA Commercial |
$4,859.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,466.60
|
| Rate for Payer: Humana ChoiceCare |
$1,579.24
|
| Rate for Payer: Multiplan All |
$5,527.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,644.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,251.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,466.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,770.30
|
| Rate for Payer: Three Rivers Provider Network All |
$4,555.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,345.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,518.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,648.82
|
| Rate for Payer: Zelis Auto |
$2,429.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,037.00
|
|
|
IMPLT PLATE TIB PROX 85MM 5 HL 3 BN LT
|
Facility
|
IP
|
$5,912.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.80 |
| Max. Negotiated Rate |
$5,616.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,729.60
|
| Rate for Payer: Cash Price |
$3,547.20
|
| Rate for Payer: Cash Price |
$3,547.20
|
| Rate for Payer: Cigna Commercial |
$5,025.20
|
| Rate for Payer: First Health Commercial |
$5,320.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,320.80
|
| Rate for Payer: GEHA Commercial |
$4,138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,320.80
|
| Rate for Payer: Multiplan All |
$5,379.92
|
| Rate for Payer: OMNI Networks Commercial |
$4,138.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,320.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,616.40
|
| Rate for Payer: Three Rivers Provider Network All |
$4,434.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,498.16
|
| Rate for Payer: Zelis Auto |
$2,364.80
|
|
|
IMPLT PLATE TIB PROX 85MM 5 HL 3 BN LT
|
Facility
|
OP
|
$5,912.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,478.00 |
| Max. Negotiated Rate |
$5,616.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,547.20
|
| Rate for Payer: Cash Price |
$3,547.20
|
| Rate for Payer: Cash Price |
$3,547.20
|
| Rate for Payer: Cigna Commercial |
$5,025.20
|
| Rate for Payer: First Health Commercial |
$5,320.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,320.80
|
| Rate for Payer: GEHA Commercial |
$4,729.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,320.80
|
| Rate for Payer: Humana ChoiceCare |
$1,537.12
|
| Rate for Payer: Multiplan All |
$5,379.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,547.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,138.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,320.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,616.40
|
| Rate for Payer: Three Rivers Provider Network All |
$4,434.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,202.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,478.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,498.16
|
| Rate for Payer: Zelis Auto |
$2,364.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,956.00
|
|
