|
IMPLT PIN STEINMANN POINT DIAMOND 7/64
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$107.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Humana ChoiceCare |
$34.84
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$80.40
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$117.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.00
|
|
|
IMPLT PIN STEINMANN POINT DIAMOND 9/64
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$119.85
|
| Rate for Payer: First Health Commercial |
$126.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.90
|
| Rate for Payer: GEHA Commercial |
$112.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.90
|
| Rate for Payer: Humana ChoiceCare |
$36.66
|
| Rate for Payer: Multiplan All |
$128.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$84.60
|
| Rate for Payer: OMNI Networks Commercial |
$98.70
|
| Rate for Payer: One Health Plan PPO/POS |
$126.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.95
|
| Rate for Payer: Three Rivers Provider Network All |
$105.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$124.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$131.13
|
| Rate for Payer: Zelis Auto |
$56.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$70.50
|
|
|
IMPLT PIN STEINMANN POINT DIAMOND 9/64
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.80
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$119.85
|
| Rate for Payer: First Health Commercial |
$126.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.90
|
| Rate for Payer: GEHA Commercial |
$98.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.90
|
| Rate for Payer: Multiplan All |
$128.31
|
| Rate for Payer: OMNI Networks Commercial |
$98.70
|
| Rate for Payer: One Health Plan PPO/POS |
$126.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.95
|
| Rate for Payer: Three Rivers Provider Network All |
$105.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$131.13
|
| Rate for Payer: Zelis Auto |
$56.40
|
|
|
IMPLT PIN STEINMANN REVERSE SHOULDER
|
Facility
|
OP
|
$1,033.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.25 |
| Max. Negotiated Rate |
$981.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$619.80
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cigna Commercial |
$878.05
|
| Rate for Payer: First Health Commercial |
$929.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$929.70
|
| Rate for Payer: GEHA Commercial |
$826.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$929.70
|
| Rate for Payer: Humana ChoiceCare |
$268.58
|
| Rate for Payer: Multiplan All |
$940.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$619.80
|
| Rate for Payer: OMNI Networks Commercial |
$723.10
|
| Rate for Payer: One Health Plan PPO/POS |
$929.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$981.35
|
| Rate for Payer: Three Rivers Provider Network All |
$774.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$909.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$258.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$960.69
|
| Rate for Payer: Zelis Auto |
$413.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$516.50
|
|
|
IMPLT PIN STEINMANN REVERSE SHOULDER
|
Facility
|
IP
|
$1,033.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.20 |
| Max. Negotiated Rate |
$981.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$826.40
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cigna Commercial |
$878.05
|
| Rate for Payer: First Health Commercial |
$929.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$929.70
|
| Rate for Payer: GEHA Commercial |
$723.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$929.70
|
| Rate for Payer: Multiplan All |
$940.03
|
| Rate for Payer: OMNI Networks Commercial |
$723.10
|
| Rate for Payer: One Health Plan PPO/POS |
$929.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$981.35
|
| Rate for Payer: Three Rivers Provider Network All |
$774.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$960.69
|
| Rate for Payer: Zelis Auto |
$413.20
|
|
|
IMPLT PIN TRIM IT 1.5X100MM
|
Facility
|
OP
|
$2,042.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.50 |
| Max. Negotiated Rate |
$1,939.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,225.20
|
| Rate for Payer: Cash Price |
$1,225.20
|
| Rate for Payer: Cash Price |
$1,225.20
|
| Rate for Payer: Cigna Commercial |
$1,735.70
|
| Rate for Payer: First Health Commercial |
$1,837.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,837.80
|
| Rate for Payer: GEHA Commercial |
$1,633.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,837.80
|
| Rate for Payer: Humana ChoiceCare |
$530.92
|
| Rate for Payer: Multiplan All |
$1,858.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,225.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,429.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,837.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,939.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,531.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,796.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$510.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,899.06
|
| Rate for Payer: Zelis Auto |
$816.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,021.00
|
|
|
IMPLT PIN TRIM IT 1.5X100MM
|
Facility
|
IP
|
$2,042.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$816.80 |
| Max. Negotiated Rate |
$1,939.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,633.60
|
| Rate for Payer: Cash Price |
$1,225.20
|
| Rate for Payer: Cash Price |
$1,225.20
|
| Rate for Payer: Cigna Commercial |
$1,735.70
|
| Rate for Payer: First Health Commercial |
$1,837.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,837.80
|
| Rate for Payer: GEHA Commercial |
$1,429.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,837.80
|
| Rate for Payer: Multiplan All |
$1,858.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,429.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,837.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,939.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,531.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,899.06
|
| Rate for Payer: Zelis Auto |
$816.80
|
|
|
IMPLT PIN TROCAR GEN 1/8
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$37.60
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: First Health Commercial |
$42.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.30
|
| Rate for Payer: GEHA Commercial |
$32.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.30
|
| Rate for Payer: Multiplan All |
$42.77
|
| Rate for Payer: OMNI Networks Commercial |
$32.90
|
| Rate for Payer: One Health Plan PPO/POS |
$42.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$44.65
|
| Rate for Payer: Three Rivers Provider Network All |
$35.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$43.71
|
| Rate for Payer: Zelis Auto |
$18.80
|
|
|
IMPLT PIN TROCAR GEN 1/8
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: First Health Commercial |
$42.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.30
|
| Rate for Payer: GEHA Commercial |
$37.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.30
|
| Rate for Payer: Humana ChoiceCare |
$12.22
|
| Rate for Payer: Multiplan All |
$42.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.20
|
| Rate for Payer: OMNI Networks Commercial |
$32.90
|
| Rate for Payer: One Health Plan PPO/POS |
$42.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$44.65
|
| Rate for Payer: Three Rivers Provider Network All |
$35.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$43.71
|
| Rate for Payer: Zelis Auto |
$18.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.50
|
|
|
IMPLT PL 11H R 147MM OLEC 2.7/3.5MM EVOS
|
Facility
|
OP
|
$4,278.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.50 |
| Max. Negotiated Rate |
$4,064.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cigna Commercial |
$3,636.30
|
| Rate for Payer: First Health Commercial |
$3,850.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,850.20
|
| Rate for Payer: GEHA Commercial |
$3,422.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,850.20
|
| Rate for Payer: Humana ChoiceCare |
$1,112.28
|
| Rate for Payer: Multiplan All |
$3,892.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,566.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,994.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,850.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,064.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,208.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,764.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,069.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,978.54
|
| Rate for Payer: Zelis Auto |
$1,711.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,139.00
|
|
|
IMPLT PL 11H R 147MM OLEC 2.7/3.5MM EVOS
|
Facility
|
IP
|
$4,278.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,711.20 |
| Max. Negotiated Rate |
$4,064.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,422.40
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cigna Commercial |
$3,636.30
|
| Rate for Payer: First Health Commercial |
$3,850.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,850.20
|
| Rate for Payer: GEHA Commercial |
$2,994.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,850.20
|
| Rate for Payer: Multiplan All |
$3,892.98
|
| Rate for Payer: OMNI Networks Commercial |
$2,994.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,850.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,064.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,978.54
|
| Rate for Payer: Zelis Auto |
$1,711.20
|
|
|
IMPLT PLATE
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,639.20
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,309.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
|
|
IMPLT PLATE
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,639.20
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,309.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
|
|
IMPLT PLATE
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.75 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Humana ChoiceCare |
$857.74
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,979.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,903.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,649.50
|
|
|
IMPLT PLATE
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.75 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Humana ChoiceCare |
$857.74
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,979.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,903.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,649.50
|
|
|
IMPLT PLATE 10 HOLE 49MM XSH
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,639.20
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,309.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
|
|
IMPLT PLATE 10 HOLE 49MM XSH
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.75 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Humana ChoiceCare |
$857.74
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,979.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,903.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,649.50
|
|
|
IMPLT PLATE 10 HOLE WIDE LEFT
|
Facility
|
OP
|
$3,136.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$784.00 |
| Max. Negotiated Rate |
$2,979.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,881.60
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cigna Commercial |
$2,665.60
|
| Rate for Payer: First Health Commercial |
$2,822.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,822.40
|
| Rate for Payer: GEHA Commercial |
$2,508.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,822.40
|
| Rate for Payer: Humana ChoiceCare |
$815.36
|
| Rate for Payer: Multiplan All |
$2,853.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,881.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,195.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,822.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,979.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,352.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,759.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$784.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,916.48
|
| Rate for Payer: Zelis Auto |
$1,254.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,568.00
|
|
|
IMPLT PLATE 10 HOLE WIDE LEFT
|
Facility
|
IP
|
$3,136.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,254.40 |
| Max. Negotiated Rate |
$2,979.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,508.80
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cigna Commercial |
$2,665.60
|
| Rate for Payer: First Health Commercial |
$2,822.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,822.40
|
| Rate for Payer: GEHA Commercial |
$2,195.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,822.40
|
| Rate for Payer: Multiplan All |
$2,853.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,195.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,822.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,979.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,352.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,916.48
|
| Rate for Payer: Zelis Auto |
$1,254.40
|
|
|
IMPLT PLATE,11H,LEFT,155MM
|
Facility
|
OP
|
$2,858.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.50 |
| Max. Negotiated Rate |
$2,715.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,714.80
|
| Rate for Payer: Cash Price |
$1,714.80
|
| Rate for Payer: Cash Price |
$1,714.80
|
| Rate for Payer: Cigna Commercial |
$2,429.30
|
| Rate for Payer: First Health Commercial |
$2,572.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,572.20
|
| Rate for Payer: GEHA Commercial |
$2,286.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,572.20
|
| Rate for Payer: Humana ChoiceCare |
$743.08
|
| Rate for Payer: Multiplan All |
$2,600.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,714.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,000.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,572.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,715.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,143.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,515.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,657.94
|
| Rate for Payer: Zelis Auto |
$1,143.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,429.00
|
|
|
IMPLT PLATE,11H,LEFT,155MM
|
Facility
|
IP
|
$2,858.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,143.20 |
| Max. Negotiated Rate |
$2,715.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,286.40
|
| Rate for Payer: Cash Price |
$1,714.80
|
| Rate for Payer: Cash Price |
$1,714.80
|
| Rate for Payer: Cigna Commercial |
$2,429.30
|
| Rate for Payer: First Health Commercial |
$2,572.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,572.20
|
| Rate for Payer: GEHA Commercial |
$2,000.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,572.20
|
| Rate for Payer: Multiplan All |
$2,600.78
|
| Rate for Payer: OMNI Networks Commercial |
$2,000.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,572.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,715.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,143.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,657.94
|
| Rate for Payer: Zelis Auto |
$1,143.20
|
|
|
IMPLT PLATE 11 HOLE SHORT
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.75 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Humana ChoiceCare |
$857.74
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,979.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,903.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,649.50
|
|
|
IMPLT PLATE 11 HOLE SHORT
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,639.20
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,309.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
|
|
IMPLT PLATE,11H,RIGHT,155MM
|
Facility
|
IP
|
$2,858.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,143.20 |
| Max. Negotiated Rate |
$2,715.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,286.40
|
| Rate for Payer: Cash Price |
$1,714.80
|
| Rate for Payer: Cash Price |
$1,714.80
|
| Rate for Payer: Cigna Commercial |
$2,429.30
|
| Rate for Payer: First Health Commercial |
$2,572.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,572.20
|
| Rate for Payer: GEHA Commercial |
$2,000.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,572.20
|
| Rate for Payer: Multiplan All |
$2,600.78
|
| Rate for Payer: OMNI Networks Commercial |
$2,000.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,572.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,715.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,143.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,657.94
|
| Rate for Payer: Zelis Auto |
$1,143.20
|
|
|
IMPLT PLATE,11H,RIGHT,155MM
|
Facility
|
OP
|
$2,858.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.50 |
| Max. Negotiated Rate |
$2,715.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,714.80
|
| Rate for Payer: Cash Price |
$1,714.80
|
| Rate for Payer: Cash Price |
$1,714.80
|
| Rate for Payer: Cigna Commercial |
$2,429.30
|
| Rate for Payer: First Health Commercial |
$2,572.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,572.20
|
| Rate for Payer: GEHA Commercial |
$2,286.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,572.20
|
| Rate for Payer: Humana ChoiceCare |
$743.08
|
| Rate for Payer: Multiplan All |
$2,600.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,714.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,000.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,572.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,715.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,143.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,515.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,657.94
|
| Rate for Payer: Zelis Auto |
$1,143.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,429.00
|
|
