|
IMPLT POSTERIOR FEMORAL #6 RIGHT
|
Facility
|
IP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,442.00 |
| Max. Negotiated Rate |
$5,799.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,884.00
|
| Rate for Payer: Cash Price |
$3,663.00
|
| Rate for Payer: Cash Price |
$3,663.00
|
| Rate for Payer: Cigna Commercial |
$5,189.25
|
| Rate for Payer: First Health Commercial |
$5,494.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,494.50
|
| Rate for Payer: GEHA Commercial |
$4,273.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,494.50
|
| Rate for Payer: Multiplan All |
$5,555.55
|
| Rate for Payer: OMNI Networks Commercial |
$4,273.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,494.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,799.75
|
| Rate for Payer: Three Rivers Provider Network All |
$4,578.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,677.65
|
| Rate for Payer: Zelis Auto |
$2,442.00
|
|
|
IMPLT POSTERIOR FEMORAL #6 RIGHT
|
Facility
|
OP
|
$6,105.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,526.25 |
| Max. Negotiated Rate |
$5,799.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,663.00
|
| Rate for Payer: Cash Price |
$3,663.00
|
| Rate for Payer: Cash Price |
$3,663.00
|
| Rate for Payer: Cigna Commercial |
$5,189.25
|
| Rate for Payer: First Health Commercial |
$5,494.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,494.50
|
| Rate for Payer: GEHA Commercial |
$4,884.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,494.50
|
| Rate for Payer: Humana ChoiceCare |
$1,587.30
|
| Rate for Payer: Multiplan All |
$5,555.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,663.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,273.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,494.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,799.75
|
| Rate for Payer: Three Rivers Provider Network All |
$4,578.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,372.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,526.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,677.65
|
| Rate for Payer: Zelis Auto |
$2,442.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,052.50
|
|
|
IMPLT POSTERIOR FEMORAL SIZE 4 RIGHT
|
Facility
|
IP
|
$5,633.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,253.20 |
| Max. Negotiated Rate |
$5,351.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,506.40
|
| Rate for Payer: Cash Price |
$3,379.80
|
| Rate for Payer: Cash Price |
$3,379.80
|
| Rate for Payer: Cigna Commercial |
$4,788.05
|
| Rate for Payer: First Health Commercial |
$5,069.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,069.70
|
| Rate for Payer: GEHA Commercial |
$3,943.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,069.70
|
| Rate for Payer: Multiplan All |
$5,126.03
|
| Rate for Payer: OMNI Networks Commercial |
$3,943.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,069.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,351.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,224.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,238.69
|
| Rate for Payer: Zelis Auto |
$2,253.20
|
|
|
IMPLT POSTERIOR FEMORAL SIZE 4 RIGHT
|
Facility
|
OP
|
$5,633.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,408.25 |
| Max. Negotiated Rate |
$5,351.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,379.80
|
| Rate for Payer: Cash Price |
$3,379.80
|
| Rate for Payer: Cash Price |
$3,379.80
|
| Rate for Payer: Cigna Commercial |
$4,788.05
|
| Rate for Payer: First Health Commercial |
$5,069.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,069.70
|
| Rate for Payer: GEHA Commercial |
$4,506.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,069.70
|
| Rate for Payer: Humana ChoiceCare |
$1,464.58
|
| Rate for Payer: Multiplan All |
$5,126.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,379.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,943.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,069.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,351.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,224.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,957.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,408.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,238.69
|
| Rate for Payer: Zelis Auto |
$2,253.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,816.50
|
|
|
IMPLT POSTERIOR,FEMORAL,SIZE 6,LEFT
|
Facility
|
OP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.75 |
| Max. Negotiated Rate |
$5,516.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,484.20
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cigna Commercial |
$4,935.95
|
| Rate for Payer: First Health Commercial |
$5,226.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,226.30
|
| Rate for Payer: GEHA Commercial |
$4,645.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,226.30
|
| Rate for Payer: Humana ChoiceCare |
$1,509.82
|
| Rate for Payer: Multiplan All |
$5,284.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,484.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,064.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,226.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,516.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,355.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,110.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,451.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,400.51
|
| Rate for Payer: Zelis Auto |
$2,322.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,903.50
|
|
|
IMPLT POSTERIOR,FEMORAL,SIZE 6,LEFT
|
Facility
|
IP
|
$5,807.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,322.80 |
| Max. Negotiated Rate |
$5,516.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,645.60
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cash Price |
$3,484.20
|
| Rate for Payer: Cigna Commercial |
$4,935.95
|
| Rate for Payer: First Health Commercial |
$5,226.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,226.30
|
| Rate for Payer: GEHA Commercial |
$4,064.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,226.30
|
| Rate for Payer: Multiplan All |
$5,284.37
|
| Rate for Payer: OMNI Networks Commercial |
$4,064.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,226.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,516.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,355.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,400.51
|
| Rate for Payer: Zelis Auto |
$2,322.80
|
|
|
IMPLT POSTERIOR STABILIZED FEMORAL #5
|
Facility
|
IP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,319.20 |
| Max. Negotiated Rate |
$7,883.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,638.40
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cigna Commercial |
$7,053.30
|
| Rate for Payer: First Health Commercial |
$7,468.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,468.20
|
| Rate for Payer: GEHA Commercial |
$5,808.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,468.20
|
| Rate for Payer: Multiplan All |
$7,551.18
|
| Rate for Payer: OMNI Networks Commercial |
$5,808.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,468.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,883.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,223.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,717.14
|
| Rate for Payer: Zelis Auto |
$3,319.20
|
|
|
IMPLT POSTERIOR STABILIZED FEMORAL #5
|
Facility
|
OP
|
$8,298.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,074.50 |
| Max. Negotiated Rate |
$7,883.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cash Price |
$4,978.80
|
| Rate for Payer: Cigna Commercial |
$7,053.30
|
| Rate for Payer: First Health Commercial |
$7,468.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,468.20
|
| Rate for Payer: GEHA Commercial |
$6,638.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,468.20
|
| Rate for Payer: Humana ChoiceCare |
$2,157.48
|
| Rate for Payer: Multiplan All |
$7,551.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,978.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,808.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,468.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,883.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,223.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,302.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,074.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,717.14
|
| Rate for Payer: Zelis Auto |
$3,319.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,149.00
|
|
|
IMPLT POSTERIOR STABILIZED FEMORAL SZ 4
|
Facility
|
IP
|
$7,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,890.00 |
| Max. Negotiated Rate |
$6,863.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,780.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cigna Commercial |
$6,141.25
|
| Rate for Payer: First Health Commercial |
$6,502.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,502.50
|
| Rate for Payer: GEHA Commercial |
$5,057.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,502.50
|
| Rate for Payer: Multiplan All |
$6,574.75
|
| Rate for Payer: OMNI Networks Commercial |
$5,057.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,502.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,863.75
|
| Rate for Payer: Three Rivers Provider Network All |
$5,418.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,719.25
|
| Rate for Payer: Zelis Auto |
$2,890.00
|
|
|
IMPLT POSTERIOR STABILIZED FEMORAL SZ 4
|
Facility
|
OP
|
$7,225.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,806.25 |
| Max. Negotiated Rate |
$6,863.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,335.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cash Price |
$4,335.00
|
| Rate for Payer: Cigna Commercial |
$6,141.25
|
| Rate for Payer: First Health Commercial |
$6,502.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,502.50
|
| Rate for Payer: GEHA Commercial |
$5,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,502.50
|
| Rate for Payer: Humana ChoiceCare |
$1,878.50
|
| Rate for Payer: Multiplan All |
$6,574.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,335.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,057.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,502.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,863.75
|
| Rate for Payer: Three Rivers Provider Network All |
$5,418.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,358.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,806.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,719.25
|
| Rate for Payer: Zelis Auto |
$2,890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,612.50
|
|
|
IMPLT POST EX FIX 11MM HFMN 3 STR
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.00 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$726.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Humana ChoiceCare |
$236.08
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.80
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$799.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$227.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.00
|
|
|
IMPLT POST EX FIX 11MM HFMN 3 STR
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$363.20 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$726.40
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$635.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
|
|
IMPLT POST FIXATION 6.5X25MM
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.75 |
| Max. Negotiated Rate |
$614.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$549.95
|
| Rate for Payer: First Health Commercial |
$582.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$582.30
|
| Rate for Payer: GEHA Commercial |
$517.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$582.30
|
| Rate for Payer: Humana ChoiceCare |
$168.22
|
| Rate for Payer: Multiplan All |
$588.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$388.20
|
| Rate for Payer: OMNI Networks Commercial |
$452.90
|
| Rate for Payer: One Health Plan PPO/POS |
$582.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$614.65
|
| Rate for Payer: Three Rivers Provider Network All |
$485.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$161.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$601.71
|
| Rate for Payer: Zelis Auto |
$258.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$323.50
|
|
|
IMPLT POST FIXATION 6.5X25MM
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.80 |
| Max. Negotiated Rate |
$614.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$517.60
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$549.95
|
| Rate for Payer: First Health Commercial |
$582.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$582.30
|
| Rate for Payer: GEHA Commercial |
$452.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$582.30
|
| Rate for Payer: Multiplan All |
$588.77
|
| Rate for Payer: OMNI Networks Commercial |
$452.90
|
| Rate for Payer: One Health Plan PPO/POS |
$582.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$614.65
|
| Rate for Payer: Three Rivers Provider Network All |
$485.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$601.71
|
| Rate for Payer: Zelis Auto |
$258.80
|
|
|
IMPLT POST FIXATION 6.5X30MM
|
Facility
|
IP
|
$617.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$586.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.60
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$524.45
|
| Rate for Payer: First Health Commercial |
$555.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$555.30
|
| Rate for Payer: GEHA Commercial |
$431.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$555.30
|
| Rate for Payer: Multiplan All |
$561.47
|
| Rate for Payer: OMNI Networks Commercial |
$431.90
|
| Rate for Payer: One Health Plan PPO/POS |
$555.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$586.15
|
| Rate for Payer: Three Rivers Provider Network All |
$462.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$573.81
|
| Rate for Payer: Zelis Auto |
$246.80
|
|
|
IMPLT POST FIXATION 6.5X30MM
|
Facility
|
OP
|
$617.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.25 |
| Max. Negotiated Rate |
$586.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$524.45
|
| Rate for Payer: First Health Commercial |
$555.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$555.30
|
| Rate for Payer: GEHA Commercial |
$493.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$555.30
|
| Rate for Payer: Humana ChoiceCare |
$160.42
|
| Rate for Payer: Multiplan All |
$561.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$370.20
|
| Rate for Payer: OMNI Networks Commercial |
$431.90
|
| Rate for Payer: One Health Plan PPO/POS |
$555.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$586.15
|
| Rate for Payer: Three Rivers Provider Network All |
$462.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$542.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$154.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$573.81
|
| Rate for Payer: Zelis Auto |
$246.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$308.50
|
|
|
IMPLT POST GLENOID HYBRID REGENEREX
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$465.80
|
| Rate for Payer: First Health Commercial |
$493.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.20
|
| Rate for Payer: GEHA Commercial |
$438.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.20
|
| Rate for Payer: Humana ChoiceCare |
$142.48
|
| Rate for Payer: Multiplan All |
$498.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$328.80
|
| Rate for Payer: OMNI Networks Commercial |
$383.60
|
| Rate for Payer: One Health Plan PPO/POS |
$493.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$520.60
|
| Rate for Payer: Three Rivers Provider Network All |
$411.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$482.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$509.64
|
| Rate for Payer: Zelis Auto |
$219.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$274.00
|
|
|
IMPLT POST GLENOID HYBRID REGENEREX
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$438.40
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$465.80
|
| Rate for Payer: First Health Commercial |
$493.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.20
|
| Rate for Payer: GEHA Commercial |
$383.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.20
|
| Rate for Payer: Multiplan All |
$498.68
|
| Rate for Payer: OMNI Networks Commercial |
$383.60
|
| Rate for Payer: One Health Plan PPO/POS |
$493.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$520.60
|
| Rate for Payer: Three Rivers Provider Network All |
$411.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$509.64
|
| Rate for Payer: Zelis Auto |
$219.20
|
|
|
IMPLT POST GLENOID PT HYBRID
|
Facility
|
OP
|
$13,678.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,419.50 |
| Max. Negotiated Rate |
$12,994.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,206.80
|
| Rate for Payer: Cash Price |
$8,206.80
|
| Rate for Payer: Cash Price |
$8,206.80
|
| Rate for Payer: Cigna Commercial |
$11,626.30
|
| Rate for Payer: First Health Commercial |
$12,310.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12,310.20
|
| Rate for Payer: GEHA Commercial |
$10,942.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12,310.20
|
| Rate for Payer: Humana ChoiceCare |
$3,556.28
|
| Rate for Payer: Multiplan All |
$12,446.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.80
|
| Rate for Payer: OMNI Networks Commercial |
$9,574.60
|
| Rate for Payer: One Health Plan PPO/POS |
$12,310.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12,994.10
|
| Rate for Payer: Three Rivers Provider Network All |
$10,258.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,036.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,419.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12,720.54
|
| Rate for Payer: Zelis Auto |
$5,471.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,839.00
|
|
|
IMPLT POST GLENOID PT HYBRID
|
Facility
|
IP
|
$13,678.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,471.20 |
| Max. Negotiated Rate |
$12,994.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,942.40
|
| Rate for Payer: Cash Price |
$8,206.80
|
| Rate for Payer: Cash Price |
$8,206.80
|
| Rate for Payer: Cigna Commercial |
$11,626.30
|
| Rate for Payer: First Health Commercial |
$12,310.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12,310.20
|
| Rate for Payer: GEHA Commercial |
$9,574.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12,310.20
|
| Rate for Payer: Multiplan All |
$12,446.98
|
| Rate for Payer: OMNI Networks Commercial |
$9,574.60
|
| Rate for Payer: One Health Plan PPO/POS |
$12,310.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12,994.10
|
| Rate for Payer: Three Rivers Provider Network All |
$10,258.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12,720.54
|
| Rate for Payer: Zelis Auto |
$5,471.20
|
|
|
IMPLT POST SCRW 4.5X25MM
|
Facility
|
OP
|
$617.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.25 |
| Max. Negotiated Rate |
$586.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$524.45
|
| Rate for Payer: First Health Commercial |
$555.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$555.30
|
| Rate for Payer: GEHA Commercial |
$493.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$555.30
|
| Rate for Payer: Humana ChoiceCare |
$160.42
|
| Rate for Payer: Multiplan All |
$561.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$370.20
|
| Rate for Payer: OMNI Networks Commercial |
$431.90
|
| Rate for Payer: One Health Plan PPO/POS |
$555.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$586.15
|
| Rate for Payer: Three Rivers Provider Network All |
$462.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$542.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$154.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$573.81
|
| Rate for Payer: Zelis Auto |
$246.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$308.50
|
|
|
IMPLT POST SCRW 4.5X25MM
|
Facility
|
IP
|
$617.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$586.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.60
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$524.45
|
| Rate for Payer: First Health Commercial |
$555.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$555.30
|
| Rate for Payer: GEHA Commercial |
$431.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$555.30
|
| Rate for Payer: Multiplan All |
$561.47
|
| Rate for Payer: OMNI Networks Commercial |
$431.90
|
| Rate for Payer: One Health Plan PPO/POS |
$555.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$586.15
|
| Rate for Payer: Three Rivers Provider Network All |
$462.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$573.81
|
| Rate for Payer: Zelis Auto |
$246.80
|
|
|
IMPLT POST SCRW 4.5X30MM
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.50 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$673.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Humana ChoiceCare |
$218.92
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$505.20
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$740.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$210.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: Zelis Auto |
$336.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$421.00
|
|
|
IMPLT POST SCRW 4.5X30MM
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.80 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$673.60
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$589.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: Zelis Auto |
$336.80
|
|
|
IMPLT POST SCRW 4.5X35MM
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.00 |
| Max. Negotiated Rate |
$603.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$508.00
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$539.75
|
| Rate for Payer: First Health Commercial |
$571.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$571.50
|
| Rate for Payer: GEHA Commercial |
$444.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$571.50
|
| Rate for Payer: Multiplan All |
$577.85
|
| Rate for Payer: OMNI Networks Commercial |
$444.50
|
| Rate for Payer: One Health Plan PPO/POS |
$571.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$603.25
|
| Rate for Payer: Three Rivers Provider Network All |
$476.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$590.55
|
| Rate for Payer: Zelis Auto |
$254.00
|
|
