|
IMPLT PLATE TIB PROX 8 HL 3 BN RT
|
Facility
|
OP
|
$6,233.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,558.25 |
| Max. Negotiated Rate |
$5,921.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,739.80
|
| Rate for Payer: Cash Price |
$3,739.80
|
| Rate for Payer: Cash Price |
$3,739.80
|
| Rate for Payer: Cigna Commercial |
$5,298.05
|
| Rate for Payer: First Health Commercial |
$5,609.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,609.70
|
| Rate for Payer: GEHA Commercial |
$4,986.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,609.70
|
| Rate for Payer: Humana ChoiceCare |
$1,620.58
|
| Rate for Payer: Multiplan All |
$5,672.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,739.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,363.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,609.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,921.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,674.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,485.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,558.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,796.69
|
| Rate for Payer: Zelis Auto |
$2,493.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,116.50
|
|
|
IMPLT PLATE TIB PROX 8 HL 3 BN RT
|
Facility
|
IP
|
$6,233.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,493.20 |
| Max. Negotiated Rate |
$5,921.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,986.40
|
| Rate for Payer: Cash Price |
$3,739.80
|
| Rate for Payer: Cash Price |
$3,739.80
|
| Rate for Payer: Cigna Commercial |
$5,298.05
|
| Rate for Payer: First Health Commercial |
$5,609.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,609.70
|
| Rate for Payer: GEHA Commercial |
$4,363.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,609.70
|
| Rate for Payer: Multiplan All |
$5,672.03
|
| Rate for Payer: OMNI Networks Commercial |
$4,363.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,609.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,921.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,674.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,796.69
|
| Rate for Payer: Zelis Auto |
$2,493.20
|
|
|
IMPLT PLATE T OBLIQUE
|
Facility
|
IP
|
$3,083.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.20 |
| Max. Negotiated Rate |
$2,928.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,466.40
|
| Rate for Payer: Cash Price |
$1,849.80
|
| Rate for Payer: Cash Price |
$1,849.80
|
| Rate for Payer: Cigna Commercial |
$2,620.55
|
| Rate for Payer: First Health Commercial |
$2,774.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,774.70
|
| Rate for Payer: GEHA Commercial |
$2,158.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,774.70
|
| Rate for Payer: Multiplan All |
$2,805.53
|
| Rate for Payer: OMNI Networks Commercial |
$2,158.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,774.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,928.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,312.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,867.19
|
| Rate for Payer: Zelis Auto |
$1,233.20
|
|
|
IMPLT PLATE T OBLIQUE
|
Facility
|
OP
|
$3,083.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.75 |
| Max. Negotiated Rate |
$2,928.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,849.80
|
| Rate for Payer: Cash Price |
$1,849.80
|
| Rate for Payer: Cash Price |
$1,849.80
|
| Rate for Payer: Cigna Commercial |
$2,620.55
|
| Rate for Payer: First Health Commercial |
$2,774.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,774.70
|
| Rate for Payer: GEHA Commercial |
$2,466.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,774.70
|
| Rate for Payer: Humana ChoiceCare |
$801.58
|
| Rate for Payer: Multiplan All |
$2,805.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,849.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,158.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,774.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,928.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,312.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,713.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$770.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,867.19
|
| Rate for Payer: Zelis Auto |
$1,233.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,541.50
|
|
|
IMPLT PLATE T OBLIQUE RIGHT
|
Facility
|
OP
|
$3,083.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.75 |
| Max. Negotiated Rate |
$2,928.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,849.80
|
| Rate for Payer: Cash Price |
$1,849.80
|
| Rate for Payer: Cash Price |
$1,849.80
|
| Rate for Payer: Cigna Commercial |
$2,620.55
|
| Rate for Payer: First Health Commercial |
$2,774.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,774.70
|
| Rate for Payer: GEHA Commercial |
$2,466.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,774.70
|
| Rate for Payer: Humana ChoiceCare |
$801.58
|
| Rate for Payer: Multiplan All |
$2,805.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,849.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,158.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,774.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,928.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,312.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,713.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$770.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,867.19
|
| Rate for Payer: Zelis Auto |
$1,233.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,541.50
|
|
|
IMPLT PLATE T OBLIQUE RIGHT
|
Facility
|
IP
|
$3,083.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.20 |
| Max. Negotiated Rate |
$2,928.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,466.40
|
| Rate for Payer: Cash Price |
$1,849.80
|
| Rate for Payer: Cash Price |
$1,849.80
|
| Rate for Payer: Cigna Commercial |
$2,620.55
|
| Rate for Payer: First Health Commercial |
$2,774.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,774.70
|
| Rate for Payer: GEHA Commercial |
$2,158.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,774.70
|
| Rate for Payer: Multiplan All |
$2,805.53
|
| Rate for Payer: OMNI Networks Commercial |
$2,158.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,774.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,928.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,312.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,867.19
|
| Rate for Payer: Zelis Auto |
$1,233.20
|
|
|
IMPLT PLATE TROCHANTER LARGE
|
Facility
|
OP
|
$6,724.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,681.00 |
| Max. Negotiated Rate |
$6,387.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,034.40
|
| Rate for Payer: Cash Price |
$4,034.40
|
| Rate for Payer: Cash Price |
$4,034.40
|
| Rate for Payer: Cigna Commercial |
$5,715.40
|
| Rate for Payer: First Health Commercial |
$6,051.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,051.60
|
| Rate for Payer: GEHA Commercial |
$5,379.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,051.60
|
| Rate for Payer: Humana ChoiceCare |
$1,748.24
|
| Rate for Payer: Multiplan All |
$6,118.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,034.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,706.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,051.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,387.80
|
| Rate for Payer: Three Rivers Provider Network All |
$5,043.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,917.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,253.32
|
| Rate for Payer: Zelis Auto |
$2,689.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,362.00
|
|
|
IMPLT PLATE TROCHANTER LARGE
|
Facility
|
IP
|
$6,724.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,689.60 |
| Max. Negotiated Rate |
$6,387.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,379.20
|
| Rate for Payer: Cash Price |
$4,034.40
|
| Rate for Payer: Cash Price |
$4,034.40
|
| Rate for Payer: Cigna Commercial |
$5,715.40
|
| Rate for Payer: First Health Commercial |
$6,051.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,051.60
|
| Rate for Payer: GEHA Commercial |
$4,706.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,051.60
|
| Rate for Payer: Multiplan All |
$6,118.84
|
| Rate for Payer: OMNI Networks Commercial |
$4,706.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,051.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,387.80
|
| Rate for Payer: Three Rivers Provider Network All |
$5,043.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,253.32
|
| Rate for Payer: Zelis Auto |
$2,689.60
|
|
|
IMPLT PLATE TROCHANTER MEDIUM
|
Facility
|
IP
|
$5,021.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,008.40 |
| Max. Negotiated Rate |
$4,769.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,016.80
|
| Rate for Payer: Cash Price |
$3,012.60
|
| Rate for Payer: Cash Price |
$3,012.60
|
| Rate for Payer: Cigna Commercial |
$4,267.85
|
| Rate for Payer: First Health Commercial |
$4,518.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,518.90
|
| Rate for Payer: GEHA Commercial |
$3,514.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,518.90
|
| Rate for Payer: Multiplan All |
$4,569.11
|
| Rate for Payer: OMNI Networks Commercial |
$3,514.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,518.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,769.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,765.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,669.53
|
| Rate for Payer: Zelis Auto |
$2,008.40
|
|
|
IMPLT PLATE TROCHANTER MEDIUM
|
Facility
|
OP
|
$5,021.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,255.25 |
| Max. Negotiated Rate |
$4,769.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,012.60
|
| Rate for Payer: Cash Price |
$3,012.60
|
| Rate for Payer: Cash Price |
$3,012.60
|
| Rate for Payer: Cigna Commercial |
$4,267.85
|
| Rate for Payer: First Health Commercial |
$4,518.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,518.90
|
| Rate for Payer: GEHA Commercial |
$4,016.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,518.90
|
| Rate for Payer: Humana ChoiceCare |
$1,305.46
|
| Rate for Payer: Multiplan All |
$4,569.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,012.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,514.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,518.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,769.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,765.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,418.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,255.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,669.53
|
| Rate for Payer: Zelis Auto |
$2,008.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,510.50
|
|
|
IMPLT PLATE TROCHANTER STAINLESS LGE
|
Facility
|
OP
|
$6,962.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.50 |
| Max. Negotiated Rate |
$6,613.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,177.20
|
| Rate for Payer: Cash Price |
$4,177.20
|
| Rate for Payer: Cash Price |
$4,177.20
|
| Rate for Payer: Cigna Commercial |
$5,917.70
|
| Rate for Payer: First Health Commercial |
$6,265.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,265.80
|
| Rate for Payer: GEHA Commercial |
$5,569.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,265.80
|
| Rate for Payer: Humana ChoiceCare |
$1,810.12
|
| Rate for Payer: Multiplan All |
$6,335.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,177.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,873.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,265.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,613.90
|
| Rate for Payer: Three Rivers Provider Network All |
$5,221.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,126.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,740.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,474.66
|
| Rate for Payer: Zelis Auto |
$2,784.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,481.00
|
|
|
IMPLT PLATE TROCHANTER STAINLESS LGE
|
Facility
|
IP
|
$6,962.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,784.80 |
| Max. Negotiated Rate |
$6,613.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,569.60
|
| Rate for Payer: Cash Price |
$4,177.20
|
| Rate for Payer: Cash Price |
$4,177.20
|
| Rate for Payer: Cigna Commercial |
$5,917.70
|
| Rate for Payer: First Health Commercial |
$6,265.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,265.80
|
| Rate for Payer: GEHA Commercial |
$4,873.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,265.80
|
| Rate for Payer: Multiplan All |
$6,335.42
|
| Rate for Payer: OMNI Networks Commercial |
$4,873.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,265.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,613.90
|
| Rate for Payer: Three Rivers Provider Network All |
$5,221.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,474.66
|
| Rate for Payer: Zelis Auto |
$2,784.80
|
|
|
IMPLT PLATE TROCHANTER STAINLESS MED
|
Facility
|
IP
|
$6,962.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,784.80 |
| Max. Negotiated Rate |
$6,613.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,569.60
|
| Rate for Payer: Cash Price |
$4,177.20
|
| Rate for Payer: Cash Price |
$4,177.20
|
| Rate for Payer: Cigna Commercial |
$5,917.70
|
| Rate for Payer: First Health Commercial |
$6,265.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,265.80
|
| Rate for Payer: GEHA Commercial |
$4,873.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,265.80
|
| Rate for Payer: Multiplan All |
$6,335.42
|
| Rate for Payer: OMNI Networks Commercial |
$4,873.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,265.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,613.90
|
| Rate for Payer: Three Rivers Provider Network All |
$5,221.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,474.66
|
| Rate for Payer: Zelis Auto |
$2,784.80
|
|
|
IMPLT PLATE TROCHANTER STAINLESS MED
|
Facility
|
OP
|
$6,962.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.50 |
| Max. Negotiated Rate |
$6,613.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,177.20
|
| Rate for Payer: Cash Price |
$4,177.20
|
| Rate for Payer: Cash Price |
$4,177.20
|
| Rate for Payer: Cigna Commercial |
$5,917.70
|
| Rate for Payer: First Health Commercial |
$6,265.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,265.80
|
| Rate for Payer: GEHA Commercial |
$5,569.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,265.80
|
| Rate for Payer: Humana ChoiceCare |
$1,810.12
|
| Rate for Payer: Multiplan All |
$6,335.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,177.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,873.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,265.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,613.90
|
| Rate for Payer: Three Rivers Provider Network All |
$5,221.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,126.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,740.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,474.66
|
| Rate for Payer: Zelis Auto |
$2,784.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,481.00
|
|
|
IMPLT PLATE T TI P-AX LCK LOPRO VARIAX
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,681.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$1,504.50
|
| Rate for Payer: First Health Commercial |
$1,593.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,593.00
|
| Rate for Payer: GEHA Commercial |
$1,416.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,593.00
|
| Rate for Payer: Humana ChoiceCare |
$460.20
|
| Rate for Payer: Multiplan All |
$1,610.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,062.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,239.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,593.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,681.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,327.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,557.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$442.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,646.10
|
| Rate for Payer: Zelis Auto |
$708.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$885.00
|
|
|
IMPLT PLATE T TI P-AX LCK LOPRO VARIAX
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.00 |
| Max. Negotiated Rate |
$1,681.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$1,504.50
|
| Rate for Payer: First Health Commercial |
$1,593.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,593.00
|
| Rate for Payer: GEHA Commercial |
$1,239.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,593.00
|
| Rate for Payer: Multiplan All |
$1,610.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,239.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,593.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,681.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,327.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,646.10
|
| Rate for Payer: Zelis Auto |
$708.00
|
|
|
IMPLT PLATE TUBULAR 10 HOLE 117MM
|
Facility
|
OP
|
$1,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.00 |
| Max. Negotiated Rate |
$1,071.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$676.80
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cigna Commercial |
$958.80
|
| Rate for Payer: First Health Commercial |
$1,015.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,015.20
|
| Rate for Payer: GEHA Commercial |
$902.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,015.20
|
| Rate for Payer: Humana ChoiceCare |
$293.28
|
| Rate for Payer: Multiplan All |
$1,026.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$676.80
|
| Rate for Payer: OMNI Networks Commercial |
$789.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,015.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,071.60
|
| Rate for Payer: Three Rivers Provider Network All |
$846.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$992.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,049.04
|
| Rate for Payer: Zelis Auto |
$451.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$564.00
|
|
|
IMPLT PLATE TUBULAR 10 HOLE 117MM
|
Facility
|
IP
|
$1,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,071.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$902.40
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cigna Commercial |
$958.80
|
| Rate for Payer: First Health Commercial |
$1,015.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,015.20
|
| Rate for Payer: GEHA Commercial |
$789.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,015.20
|
| Rate for Payer: Multiplan All |
$1,026.48
|
| Rate for Payer: OMNI Networks Commercial |
$789.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,015.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,071.60
|
| Rate for Payer: Three Rivers Provider Network All |
$846.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,049.04
|
| Rate for Payer: Zelis Auto |
$451.20
|
|
|
IMPLT PLATE TUBULAR 10 HOLE 93MM
|
Facility
|
OP
|
$1,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.00 |
| Max. Negotiated Rate |
$1,071.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$676.80
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cigna Commercial |
$958.80
|
| Rate for Payer: First Health Commercial |
$1,015.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,015.20
|
| Rate for Payer: GEHA Commercial |
$902.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,015.20
|
| Rate for Payer: Humana ChoiceCare |
$293.28
|
| Rate for Payer: Multiplan All |
$1,026.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$676.80
|
| Rate for Payer: OMNI Networks Commercial |
$789.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,015.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,071.60
|
| Rate for Payer: Three Rivers Provider Network All |
$846.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$992.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,049.04
|
| Rate for Payer: Zelis Auto |
$451.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$564.00
|
|
|
IMPLT PLATE TUBULAR 10 HOLE 93MM
|
Facility
|
IP
|
$1,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,071.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$902.40
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cigna Commercial |
$958.80
|
| Rate for Payer: First Health Commercial |
$1,015.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,015.20
|
| Rate for Payer: GEHA Commercial |
$789.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,015.20
|
| Rate for Payer: Multiplan All |
$1,026.48
|
| Rate for Payer: OMNI Networks Commercial |
$789.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,015.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,071.60
|
| Rate for Payer: Three Rivers Provider Network All |
$846.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,049.04
|
| Rate for Payer: Zelis Auto |
$451.20
|
|
|
IMPLT PLATE TUBULAR 1/3 HOLE 6
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$289.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Humana ChoiceCare |
$94.12
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.20
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$318.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.00
|
|
|
IMPLT PLATE TUBULAR 1/3 HOLE 6
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.80 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$289.60
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$253.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
|
|
IMPLT PLATE TUBULAR 3.5MM
|
Facility
|
IP
|
$2,145.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.00 |
| Max. Negotiated Rate |
$2,037.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cigna Commercial |
$1,823.25
|
| Rate for Payer: First Health Commercial |
$1,930.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,930.50
|
| Rate for Payer: GEHA Commercial |
$1,501.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,930.50
|
| Rate for Payer: Multiplan All |
$1,951.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,501.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,930.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,037.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,608.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,994.85
|
| Rate for Payer: Zelis Auto |
$858.00
|
|
|
IMPLT PLATE TUBULAR 3.5MM
|
Facility
|
OP
|
$2,145.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$2,037.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,287.00
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cigna Commercial |
$1,823.25
|
| Rate for Payer: First Health Commercial |
$1,930.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,930.50
|
| Rate for Payer: GEHA Commercial |
$1,716.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,930.50
|
| Rate for Payer: Humana ChoiceCare |
$557.70
|
| Rate for Payer: Multiplan All |
$1,951.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,287.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,501.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,930.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,037.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,608.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,887.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$536.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,994.85
|
| Rate for Payer: Zelis Auto |
$858.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,072.50
|
|
|
IMPLT PLATE TUBULAR 3 HOLE 32MM
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.75 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$389.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Humana ChoiceCare |
$126.62
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$292.20
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$428.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: Zelis Auto |
$194.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$243.50
|
|
