|
IMPLT PLATE 121MM TI 4HL AXSOS
|
Facility
|
OP
|
$6,539.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,634.75 |
| Max. Negotiated Rate |
$6,212.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,923.40
|
| Rate for Payer: Cash Price |
$3,923.40
|
| Rate for Payer: Cash Price |
$3,923.40
|
| Rate for Payer: Cigna Commercial |
$5,558.15
|
| Rate for Payer: First Health Commercial |
$5,885.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,885.10
|
| Rate for Payer: GEHA Commercial |
$5,231.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,885.10
|
| Rate for Payer: Humana ChoiceCare |
$1,700.14
|
| Rate for Payer: Multiplan All |
$5,950.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,923.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,577.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,885.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,212.05
|
| Rate for Payer: Three Rivers Provider Network All |
$4,904.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,754.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,634.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,081.27
|
| Rate for Payer: Zelis Auto |
$2,615.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,269.50
|
|
|
IMPLT PLATE 121MM TI 4HL AXSOS
|
Facility
|
IP
|
$6,539.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,615.60 |
| Max. Negotiated Rate |
$6,212.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,231.20
|
| Rate for Payer: Cash Price |
$3,923.40
|
| Rate for Payer: Cash Price |
$3,923.40
|
| Rate for Payer: Cigna Commercial |
$5,558.15
|
| Rate for Payer: First Health Commercial |
$5,885.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,885.10
|
| Rate for Payer: GEHA Commercial |
$4,577.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,885.10
|
| Rate for Payer: Multiplan All |
$5,950.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,577.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,885.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,212.05
|
| Rate for Payer: Three Rivers Provider Network All |
$4,904.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,081.27
|
| Rate for Payer: Zelis Auto |
$2,615.60
|
|
|
IMPLT PLATE 128MM HOLE 6 VARIAX
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,923.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Humana ChoiceCare |
$950.04
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,192.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,215.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,827.00
|
|
|
IMPLT PLATE 128MM HOLE 6 VARIAX
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,557.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
|
|
IMPLT PLATE 1/3 TUBE 7 HOLE
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$356.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$378.25
|
| Rate for Payer: First Health Commercial |
$400.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$400.50
|
| Rate for Payer: GEHA Commercial |
$311.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$400.50
|
| Rate for Payer: Multiplan All |
$404.95
|
| Rate for Payer: OMNI Networks Commercial |
$311.50
|
| Rate for Payer: One Health Plan PPO/POS |
$400.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$422.75
|
| Rate for Payer: Three Rivers Provider Network All |
$333.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$413.85
|
| Rate for Payer: Zelis Auto |
$178.00
|
|
|
IMPLT PLATE 1/3 TUBE 7 HOLE
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.25 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$378.25
|
| Rate for Payer: First Health Commercial |
$400.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$400.50
|
| Rate for Payer: GEHA Commercial |
$356.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$400.50
|
| Rate for Payer: Humana ChoiceCare |
$115.70
|
| Rate for Payer: Multiplan All |
$404.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$267.00
|
| Rate for Payer: OMNI Networks Commercial |
$311.50
|
| Rate for Payer: One Health Plan PPO/POS |
$400.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$422.75
|
| Rate for Payer: Three Rivers Provider Network All |
$333.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$391.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$413.85
|
| Rate for Payer: Zelis Auto |
$178.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$222.50
|
|
|
IMPLT PLATE 1/3 TUBULAR
|
Facility
|
IP
|
$1,558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.20 |
| Max. Negotiated Rate |
$1,480.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,246.40
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cigna Commercial |
$1,324.30
|
| Rate for Payer: First Health Commercial |
$1,402.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,402.20
|
| Rate for Payer: GEHA Commercial |
$1,090.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,402.20
|
| Rate for Payer: Multiplan All |
$1,417.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,090.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,402.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,480.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,168.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,448.94
|
| Rate for Payer: Zelis Auto |
$623.20
|
|
|
IMPLT PLATE 1/3 TUBULAR
|
Facility
|
OP
|
$1,558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$389.50 |
| Max. Negotiated Rate |
$1,480.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$934.80
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cigna Commercial |
$1,324.30
|
| Rate for Payer: First Health Commercial |
$1,402.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,402.20
|
| Rate for Payer: GEHA Commercial |
$1,246.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,402.20
|
| Rate for Payer: Humana ChoiceCare |
$405.08
|
| Rate for Payer: Multiplan All |
$1,417.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$934.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,090.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,402.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,480.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,168.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,371.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$389.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,448.94
|
| Rate for Payer: Zelis Auto |
$623.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$779.00
|
|
|
IMPLT PLATE 1/3 TUBULAR 95MM 8H
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$329.00 |
| Max. Negotiated Rate |
$1,250.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$789.60
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cigna Commercial |
$1,118.60
|
| Rate for Payer: First Health Commercial |
$1,184.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,184.40
|
| Rate for Payer: GEHA Commercial |
$1,052.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,184.40
|
| Rate for Payer: Humana ChoiceCare |
$342.16
|
| Rate for Payer: Multiplan All |
$1,197.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$789.60
|
| Rate for Payer: OMNI Networks Commercial |
$921.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,184.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,250.20
|
| Rate for Payer: Three Rivers Provider Network All |
$987.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,158.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$329.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,223.88
|
| Rate for Payer: Zelis Auto |
$526.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$658.00
|
|
|
IMPLT PLATE 1/3 TUBULAR 95MM 8H
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.40 |
| Max. Negotiated Rate |
$1,250.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,052.80
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cigna Commercial |
$1,118.60
|
| Rate for Payer: First Health Commercial |
$1,184.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,184.40
|
| Rate for Payer: GEHA Commercial |
$921.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,184.40
|
| Rate for Payer: Multiplan All |
$1,197.56
|
| Rate for Payer: OMNI Networks Commercial |
$921.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,184.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,250.20
|
| Rate for Payer: Three Rivers Provider Network All |
$987.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,223.88
|
| Rate for Payer: Zelis Auto |
$526.40
|
|
|
IMPLT PLATE,1/3 TUBULAR LOCKING
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.20
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$135.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: Zelis Auto |
$77.60
|
|
|
IMPLT PLATE,1/3 TUBULAR LOCKING
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$155.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Humana ChoiceCare |
$50.44
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$116.40
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$170.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: Zelis Auto |
$77.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$97.00
|
|
|
IMPLT PLATE 1.7 LOCKING
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006737
|
|
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 PLATE 1.7 LOCKING
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006737
|
|
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,1.7mm 5 HOLE
|
Facility
|
IP
|
$2,172.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.80 |
| Max. Negotiated Rate |
$2,063.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,737.60
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cigna Commercial |
$1,846.20
|
| Rate for Payer: First Health Commercial |
$1,954.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,954.80
|
| Rate for Payer: GEHA Commercial |
$1,520.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,954.80
|
| Rate for Payer: Multiplan All |
$1,976.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,520.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,954.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,063.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,629.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,019.96
|
| Rate for Payer: Zelis Auto |
$868.80
|
|
|
IMPLT PLATE,1.7mm 5 HOLE
|
Facility
|
OP
|
$2,172.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$2,063.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cigna Commercial |
$1,846.20
|
| Rate for Payer: First Health Commercial |
$1,954.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,954.80
|
| Rate for Payer: GEHA Commercial |
$1,737.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,954.80
|
| Rate for Payer: Humana ChoiceCare |
$564.72
|
| Rate for Payer: Multiplan All |
$1,976.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,303.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,520.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,954.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,063.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,629.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,911.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$543.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,019.96
|
| Rate for Payer: Zelis Auto |
$868.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,086.00
|
|
|
IMPLT PLATE 2.4X159MM TI MAXILLOFACIAL
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,103.00 |
| Max. Negotiated Rate |
$4,191.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,647.20
|
| Rate for Payer: Cash Price |
$2,647.20
|
| Rate for Payer: Cash Price |
$2,647.20
|
| Rate for Payer: Cigna Commercial |
$3,750.20
|
| Rate for Payer: First Health Commercial |
$3,970.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,970.80
|
| Rate for Payer: GEHA Commercial |
$3,529.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,970.80
|
| Rate for Payer: Humana ChoiceCare |
$1,147.12
|
| Rate for Payer: Multiplan All |
$4,014.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,647.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,088.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,970.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,191.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,309.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,882.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,103.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,103.16
|
| Rate for Payer: Zelis Auto |
$1,764.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,206.00
|
|
|
IMPLT PLATE 2.4X159MM TI MAXILLOFACIAL
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,764.80 |
| Max. Negotiated Rate |
$4,191.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,529.60
|
| Rate for Payer: Cash Price |
$2,647.20
|
| Rate for Payer: Cash Price |
$2,647.20
|
| Rate for Payer: Cigna Commercial |
$3,750.20
|
| Rate for Payer: First Health Commercial |
$3,970.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,970.80
|
| Rate for Payer: GEHA Commercial |
$3,088.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,970.80
|
| Rate for Payer: Multiplan All |
$4,014.92
|
| Rate for Payer: OMNI Networks Commercial |
$3,088.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,970.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,191.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,309.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,103.16
|
| Rate for Payer: Zelis Auto |
$1,764.80
|
|
|
IMPLT PLATE 2.4X95MM TI MAXILLOFACIAL
|
Facility
|
OP
|
$3,331.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$832.75 |
| Max. Negotiated Rate |
$3,164.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,998.60
|
| Rate for Payer: Cash Price |
$1,998.60
|
| Rate for Payer: Cash Price |
$1,998.60
|
| Rate for Payer: Cigna Commercial |
$2,831.35
|
| Rate for Payer: First Health Commercial |
$2,997.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,997.90
|
| Rate for Payer: GEHA Commercial |
$2,664.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,997.90
|
| Rate for Payer: Humana ChoiceCare |
$866.06
|
| Rate for Payer: Multiplan All |
$3,031.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,998.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,331.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,997.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,164.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,498.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,931.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$832.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,097.83
|
| Rate for Payer: Zelis Auto |
$1,332.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,665.50
|
|
|
IMPLT PLATE 2.4X95MM TI MAXILLOFACIAL
|
Facility
|
IP
|
$3,331.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,332.40 |
| Max. Negotiated Rate |
$3,164.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,664.80
|
| Rate for Payer: Cash Price |
$1,998.60
|
| Rate for Payer: Cash Price |
$1,998.60
|
| Rate for Payer: Cigna Commercial |
$2,831.35
|
| Rate for Payer: First Health Commercial |
$2,997.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,997.90
|
| Rate for Payer: GEHA Commercial |
$2,331.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,997.90
|
| Rate for Payer: Multiplan All |
$3,031.21
|
| Rate for Payer: OMNI Networks Commercial |
$2,331.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,997.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,164.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,498.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,097.83
|
| Rate for Payer: Zelis Auto |
$1,332.40
|
|
|
IMPLT PLATE 251MM TI 14 HOLE TIBIA LT PR
|
Facility
|
OP
|
$7,132.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,783.00 |
| Max. Negotiated Rate |
$6,775.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,279.20
|
| Rate for Payer: Cash Price |
$4,279.20
|
| Rate for Payer: Cash Price |
$4,279.20
|
| Rate for Payer: Cigna Commercial |
$6,062.20
|
| Rate for Payer: First Health Commercial |
$6,418.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,418.80
|
| Rate for Payer: GEHA Commercial |
$5,705.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,418.80
|
| Rate for Payer: Humana ChoiceCare |
$1,854.32
|
| Rate for Payer: Multiplan All |
$6,490.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,279.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,992.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,418.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,775.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,349.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,276.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,783.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,632.76
|
| Rate for Payer: Zelis Auto |
$2,852.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,566.00
|
|
|
IMPLT PLATE 251MM TI 14 HOLE TIBIA LT PR
|
Facility
|
IP
|
$7,132.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,852.80 |
| Max. Negotiated Rate |
$6,775.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,705.60
|
| Rate for Payer: Cash Price |
$4,279.20
|
| Rate for Payer: Cash Price |
$4,279.20
|
| Rate for Payer: Cigna Commercial |
$6,062.20
|
| Rate for Payer: First Health Commercial |
$6,418.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,418.80
|
| Rate for Payer: GEHA Commercial |
$4,992.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,418.80
|
| Rate for Payer: Multiplan All |
$6,490.12
|
| Rate for Payer: OMNI Networks Commercial |
$4,992.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,418.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,775.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,349.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,632.76
|
| Rate for Payer: Zelis Auto |
$2,852.80
|
|
|
IMPLT PLATE,2HOLE,1/3 TUBULAR,25MM
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.25 |
| Max. Negotiated Rate |
$472.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cigna Commercial |
$422.45
|
| Rate for Payer: First Health Commercial |
$447.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$447.30
|
| Rate for Payer: GEHA Commercial |
$397.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$447.30
|
| Rate for Payer: Humana ChoiceCare |
$129.22
|
| Rate for Payer: Multiplan All |
$452.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$298.20
|
| Rate for Payer: OMNI Networks Commercial |
$347.90
|
| Rate for Payer: One Health Plan PPO/POS |
$447.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$472.15
|
| Rate for Payer: Three Rivers Provider Network All |
$372.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$437.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$462.21
|
| Rate for Payer: Zelis Auto |
$198.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$248.50
|
|
|
IMPLT PLATE,2HOLE,1/3 TUBULAR,25MM
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$472.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$397.60
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cigna Commercial |
$422.45
|
| Rate for Payer: First Health Commercial |
$447.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$447.30
|
| Rate for Payer: GEHA Commercial |
$347.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$447.30
|
| Rate for Payer: Multiplan All |
$452.27
|
| Rate for Payer: OMNI Networks Commercial |
$347.90
|
| Rate for Payer: One Health Plan PPO/POS |
$447.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$472.15
|
| Rate for Payer: Three Rivers Provider Network All |
$372.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$462.21
|
| Rate for Payer: Zelis Auto |
$198.80
|
|
|
IMPLT PLATE,2X2+2 HOLE 3D
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$279.20
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$296.65
|
| Rate for Payer: First Health Commercial |
$314.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$314.10
|
| Rate for Payer: GEHA Commercial |
$244.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$314.10
|
| Rate for Payer: Multiplan All |
$317.59
|
| Rate for Payer: OMNI Networks Commercial |
$244.30
|
| Rate for Payer: One Health Plan PPO/POS |
$314.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$331.55
|
| Rate for Payer: Three Rivers Provider Network All |
$261.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$324.57
|
| Rate for Payer: Zelis Auto |
$139.60
|
|
