|
IMPLT PLATE WRIST CARPAL MEDIUM
|
Facility
|
OP
|
$14,762.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,690.50 |
| Max. Negotiated Rate |
$14,023.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,857.20
|
| Rate for Payer: Cash Price |
$8,857.20
|
| Rate for Payer: Cash Price |
$8,857.20
|
| Rate for Payer: Cigna Commercial |
$12,547.70
|
| Rate for Payer: First Health Commercial |
$13,285.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,285.80
|
| Rate for Payer: GEHA Commercial |
$11,809.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,285.80
|
| Rate for Payer: Humana ChoiceCare |
$3,838.12
|
| Rate for Payer: Multiplan All |
$13,433.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,857.20
|
| Rate for Payer: OMNI Networks Commercial |
$10,333.40
|
| Rate for Payer: One Health Plan PPO/POS |
$13,285.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,023.90
|
| Rate for Payer: Three Rivers Provider Network All |
$11,071.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,990.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,690.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,728.66
|
| Rate for Payer: Zelis Auto |
$5,904.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,381.00
|
|
|
IMPLT PLATE WRIST FUSION SHORT
|
Facility
|
OP
|
$5,358.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,339.50 |
| Max. Negotiated Rate |
$5,090.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,214.80
|
| Rate for Payer: Cash Price |
$3,214.80
|
| Rate for Payer: Cash Price |
$3,214.80
|
| Rate for Payer: Cigna Commercial |
$4,554.30
|
| Rate for Payer: First Health Commercial |
$4,822.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,822.20
|
| Rate for Payer: GEHA Commercial |
$4,286.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,822.20
|
| Rate for Payer: Humana ChoiceCare |
$1,393.08
|
| Rate for Payer: Multiplan All |
$4,875.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,214.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,750.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,822.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,090.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,018.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,715.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,339.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,982.94
|
| Rate for Payer: Zelis Auto |
$2,143.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,679.00
|
|
|
IMPLT PLATE WRIST FUSION SHORT
|
Facility
|
IP
|
$5,358.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,143.20 |
| Max. Negotiated Rate |
$5,090.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,286.40
|
| Rate for Payer: Cash Price |
$3,214.80
|
| Rate for Payer: Cash Price |
$3,214.80
|
| Rate for Payer: Cigna Commercial |
$4,554.30
|
| Rate for Payer: First Health Commercial |
$4,822.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,822.20
|
| Rate for Payer: GEHA Commercial |
$3,750.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,822.20
|
| Rate for Payer: Multiplan All |
$4,875.78
|
| Rate for Payer: OMNI Networks Commercial |
$3,750.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,822.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,090.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,018.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,982.94
|
| Rate for Payer: Zelis Auto |
$2,143.20
|
|
|
IMPLT PLATE WRIST FUSION SHORT
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.80
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$609.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
|
|
IMPLT PLATE WRIST FUSION SHORT
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$696.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Humana ChoiceCare |
$226.46
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$522.60
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$766.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$217.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$435.50
|
|
|
IMPLT PLATE WRIST FUSION STANDARD
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.00 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$716.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$626.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
|
|
IMPLT PLATE WRIST FUSION STANDARD
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.75 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$716.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Humana ChoiceCare |
$232.70
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$537.00
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$787.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$447.50
|
|
|
IMPLT PLATE- Y 7 HOLE
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,513.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
|
|
IMPLT PLATE- Y 7 HOLE
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.50 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,729.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$562.12
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,297.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,902.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$540.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,081.00
|
|
|
IMPLT PLATFORM ROTATING MBT CONE SZ3
|
Facility
|
OP
|
$9,434.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,358.50 |
| Max. Negotiated Rate |
$8,962.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,660.40
|
| Rate for Payer: Cash Price |
$5,660.40
|
| Rate for Payer: Cash Price |
$5,660.40
|
| Rate for Payer: Cigna Commercial |
$8,018.90
|
| Rate for Payer: First Health Commercial |
$8,490.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,490.60
|
| Rate for Payer: GEHA Commercial |
$7,547.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,490.60
|
| Rate for Payer: Humana ChoiceCare |
$2,452.84
|
| Rate for Payer: Multiplan All |
$8,584.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,660.40
|
| Rate for Payer: OMNI Networks Commercial |
$6,603.80
|
| Rate for Payer: One Health Plan PPO/POS |
$8,490.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,962.30
|
| Rate for Payer: Three Rivers Provider Network All |
$7,075.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,301.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,358.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,773.62
|
| Rate for Payer: Zelis Auto |
$3,773.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,717.00
|
|
|
IMPLT PLATFORM ROTATING MBT CONE SZ3
|
Facility
|
IP
|
$9,434.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,773.60 |
| Max. Negotiated Rate |
$8,962.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,547.20
|
| Rate for Payer: Cash Price |
$5,660.40
|
| Rate for Payer: Cash Price |
$5,660.40
|
| Rate for Payer: Cigna Commercial |
$8,018.90
|
| Rate for Payer: First Health Commercial |
$8,490.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,490.60
|
| Rate for Payer: GEHA Commercial |
$6,603.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,490.60
|
| Rate for Payer: Multiplan All |
$8,584.94
|
| Rate for Payer: OMNI Networks Commercial |
$6,603.80
|
| Rate for Payer: One Health Plan PPO/POS |
$8,490.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,962.30
|
| Rate for Payer: Three Rivers Provider Network All |
$7,075.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,773.62
|
| Rate for Payer: Zelis Auto |
$3,773.60
|
|
|
IMPLT PLUG CANCELLOUS WITH CARTILAGE 7MM
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$757.60 |
| Max. Negotiated Rate |
$1,799.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,515.20
|
| Rate for Payer: Cash Price |
$1,136.40
|
| Rate for Payer: Cash Price |
$1,136.40
|
| Rate for Payer: Cigna Commercial |
$1,609.90
|
| Rate for Payer: First Health Commercial |
$1,704.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,704.60
|
| Rate for Payer: GEHA Commercial |
$1,325.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,704.60
|
| Rate for Payer: Multiplan All |
$1,723.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,325.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,704.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,799.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,420.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,761.42
|
| Rate for Payer: Zelis Auto |
$757.60
|
|
|
IMPLT PLUG CANCELLOUS WITH CARTILAGE 7MM
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$473.50 |
| Max. Negotiated Rate |
$1,799.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,136.40
|
| Rate for Payer: Cash Price |
$1,136.40
|
| Rate for Payer: Cash Price |
$1,136.40
|
| Rate for Payer: Cigna Commercial |
$1,609.90
|
| Rate for Payer: First Health Commercial |
$1,704.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,704.60
|
| Rate for Payer: GEHA Commercial |
$1,515.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,704.60
|
| Rate for Payer: Humana ChoiceCare |
$492.44
|
| Rate for Payer: Multiplan All |
$1,723.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,136.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,325.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,704.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,799.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,420.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,666.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$473.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,761.42
|
| Rate for Payer: Zelis Auto |
$757.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$947.00
|
|
|
IMPLT PLUG CANCELLOUS WITH CARTILAGE 9MM
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$473.50 |
| Max. Negotiated Rate |
$1,799.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,136.40
|
| Rate for Payer: Cash Price |
$1,136.40
|
| Rate for Payer: Cash Price |
$1,136.40
|
| Rate for Payer: Cigna Commercial |
$1,609.90
|
| Rate for Payer: First Health Commercial |
$1,704.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,704.60
|
| Rate for Payer: GEHA Commercial |
$1,515.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,704.60
|
| Rate for Payer: Humana ChoiceCare |
$492.44
|
| Rate for Payer: Multiplan All |
$1,723.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,136.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,325.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,704.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,799.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,420.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,666.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$473.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,761.42
|
| Rate for Payer: Zelis Auto |
$757.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$947.00
|
|
|
IMPLT PLUG CANCELLOUS WITH CARTILAGE 9MM
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$757.60 |
| Max. Negotiated Rate |
$1,799.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,515.20
|
| Rate for Payer: Cash Price |
$1,136.40
|
| Rate for Payer: Cash Price |
$1,136.40
|
| Rate for Payer: Cigna Commercial |
$1,609.90
|
| Rate for Payer: First Health Commercial |
$1,704.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,704.60
|
| Rate for Payer: GEHA Commercial |
$1,325.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,704.60
|
| Rate for Payer: Multiplan All |
$1,723.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,325.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,704.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,799.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,420.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,761.42
|
| Rate for Payer: Zelis Auto |
$757.60
|
|
|
IMPLT PLUG HOLE APICAL
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$422.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$369.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
|
|
IMPLT PLUG HOLE APICAL
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$422.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Humana ChoiceCare |
$137.28
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$316.80
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$464.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$132.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.00
|
|
|
IMPLT PLUG HOLE DOME ACETABULAR
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.75 |
| Max. Negotiated Rate |
$652.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$583.95
|
| Rate for Payer: First Health Commercial |
$618.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$618.30
|
| Rate for Payer: GEHA Commercial |
$549.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$618.30
|
| Rate for Payer: Humana ChoiceCare |
$178.62
|
| Rate for Payer: Multiplan All |
$625.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$412.20
|
| Rate for Payer: OMNI Networks Commercial |
$480.90
|
| Rate for Payer: One Health Plan PPO/POS |
$618.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$652.65
|
| Rate for Payer: Three Rivers Provider Network All |
$515.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$604.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$638.91
|
| Rate for Payer: Zelis Auto |
$274.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.50
|
|
|
IMPLT PLUG HOLE DOME ACETABULAR
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.80 |
| Max. Negotiated Rate |
$652.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$549.60
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$583.95
|
| Rate for Payer: First Health Commercial |
$618.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$618.30
|
| Rate for Payer: GEHA Commercial |
$480.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$618.30
|
| Rate for Payer: Multiplan All |
$625.17
|
| Rate for Payer: OMNI Networks Commercial |
$480.90
|
| Rate for Payer: One Health Plan PPO/POS |
$618.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$652.65
|
| Rate for Payer: Three Rivers Provider Network All |
$515.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$638.91
|
| Rate for Payer: Zelis Auto |
$274.80
|
|
|
IMPLT PLUG SHOULDER SMALL
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.75 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$716.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Humana ChoiceCare |
$232.70
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$537.00
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$787.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$447.50
|
|
|
IMPLT PLUG SHOULDER SMALL
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.00 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$716.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$626.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
|
|
IMPLT POL TRIA 4.8 X 18
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
7006798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.50 |
| Max. Negotiated Rate |
$742.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$469.20
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$664.70
|
| Rate for Payer: First Health Commercial |
$703.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$703.80
|
| Rate for Payer: GEHA Commercial |
$625.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$703.80
|
| Rate for Payer: Humana ChoiceCare |
$203.32
|
| Rate for Payer: Multiplan All |
$711.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$469.20
|
| Rate for Payer: OMNI Networks Commercial |
$547.40
|
| Rate for Payer: One Health Plan PPO/POS |
$703.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$742.90
|
| Rate for Payer: Three Rivers Provider Network All |
$586.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$688.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$727.26
|
| Rate for Payer: Zelis Auto |
$312.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$391.00
|
|
|
IMPLT POL TRIA 4.8 X 18
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
7006798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$742.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$625.60
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$664.70
|
| Rate for Payer: First Health Commercial |
$703.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$703.80
|
| Rate for Payer: GEHA Commercial |
$547.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$703.80
|
| Rate for Payer: Multiplan All |
$711.62
|
| Rate for Payer: OMNI Networks Commercial |
$547.40
|
| Rate for Payer: One Health Plan PPO/POS |
$703.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$742.90
|
| Rate for Payer: Three Rivers Provider Network All |
$586.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$727.26
|
| Rate for Payer: Zelis Auto |
$312.80
|
|
|
IMPLT POL TRIA 4.8 X 20
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
7006794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$742.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$625.60
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$664.70
|
| Rate for Payer: First Health Commercial |
$703.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$703.80
|
| Rate for Payer: GEHA Commercial |
$547.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$703.80
|
| Rate for Payer: Multiplan All |
$711.62
|
| Rate for Payer: OMNI Networks Commercial |
$547.40
|
| Rate for Payer: One Health Plan PPO/POS |
$703.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$742.90
|
| Rate for Payer: Three Rivers Provider Network All |
$586.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$727.26
|
| Rate for Payer: Zelis Auto |
$312.80
|
|
|
IMPLT POL TRIA 4.8 X 20
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
7006794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.50 |
| Max. Negotiated Rate |
$742.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$469.20
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$664.70
|
| Rate for Payer: First Health Commercial |
$703.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$703.80
|
| Rate for Payer: GEHA Commercial |
$625.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$703.80
|
| Rate for Payer: Humana ChoiceCare |
$203.32
|
| Rate for Payer: Multiplan All |
$711.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$469.20
|
| Rate for Payer: OMNI Networks Commercial |
$547.40
|
| Rate for Payer: One Health Plan PPO/POS |
$703.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$742.90
|
| Rate for Payer: Three Rivers Provider Network All |
$586.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$688.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$727.26
|
| Rate for Payer: Zelis Auto |
$312.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$391.00
|
|
