|
IMPLT PLATE,2X2+2 HOLE 3D
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.25 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$209.40
|
| 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 |
$279.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$314.10
|
| Rate for Payer: Humana ChoiceCare |
$90.74
|
| Rate for Payer: Multiplan All |
$317.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$209.40
|
| 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: TriWest Veterans Administration/VAPC3 |
$307.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$87.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$324.57
|
| Rate for Payer: Zelis Auto |
$139.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$174.50
|
|
|
IMPLT PLATE 3.5 LCP 12X168MM
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$123.25
|
| Rate for Payer: First Health Commercial |
$130.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$130.50
|
| Rate for Payer: GEHA Commercial |
$101.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$130.50
|
| Rate for Payer: Multiplan All |
$131.95
|
| Rate for Payer: OMNI Networks Commercial |
$101.50
|
| Rate for Payer: One Health Plan PPO/POS |
$130.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$137.75
|
| Rate for Payer: Three Rivers Provider Network All |
$108.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$134.85
|
| Rate for Payer: Zelis Auto |
$58.00
|
|
|
IMPLT PLATE 3.5 LCP 12X168MM
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.25 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$123.25
|
| Rate for Payer: First Health Commercial |
$130.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$130.50
|
| Rate for Payer: GEHA Commercial |
$116.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$130.50
|
| Rate for Payer: Humana ChoiceCare |
$37.70
|
| Rate for Payer: Multiplan All |
$131.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$87.00
|
| Rate for Payer: OMNI Networks Commercial |
$101.50
|
| Rate for Payer: One Health Plan PPO/POS |
$130.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$137.75
|
| Rate for Payer: Three Rivers Provider Network All |
$108.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$127.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$134.85
|
| Rate for Payer: Zelis Auto |
$58.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$72.50
|
|
|
IMPLT PLATE,3.5MM 6 HOLE 96MM
|
Facility
|
IP
|
$1,432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.80 |
| Max. Negotiated Rate |
$1,360.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,145.60
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cigna Commercial |
$1,217.20
|
| Rate for Payer: First Health Commercial |
$1,288.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,288.80
|
| Rate for Payer: GEHA Commercial |
$1,002.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,288.80
|
| Rate for Payer: Multiplan All |
$1,303.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,002.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,288.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,360.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,331.76
|
| Rate for Payer: Zelis Auto |
$572.80
|
|
|
IMPLT PLATE,3.5MM 6 HOLE 96MM
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.00 |
| Max. Negotiated Rate |
$1,360.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cigna Commercial |
$1,217.20
|
| Rate for Payer: First Health Commercial |
$1,288.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,288.80
|
| Rate for Payer: GEHA Commercial |
$1,145.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,288.80
|
| Rate for Payer: Humana ChoiceCare |
$372.32
|
| Rate for Payer: Multiplan All |
$1,303.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$859.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,002.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,288.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,360.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,260.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$358.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,331.76
|
| Rate for Payer: Zelis Auto |
$572.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$716.00
|
|
|
IMPLT PLATE 3.5MM 8 HOLE
|
Facility
|
OP
|
$994.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$944.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$596.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cigna Commercial |
$844.90
|
| Rate for Payer: First Health Commercial |
$894.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$894.60
|
| Rate for Payer: GEHA Commercial |
$795.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$894.60
|
| Rate for Payer: Humana ChoiceCare |
$258.44
|
| Rate for Payer: Multiplan All |
$904.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$596.40
|
| Rate for Payer: OMNI Networks Commercial |
$695.80
|
| Rate for Payer: One Health Plan PPO/POS |
$894.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$944.30
|
| Rate for Payer: Three Rivers Provider Network All |
$745.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$874.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$248.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$924.42
|
| Rate for Payer: Zelis Auto |
$397.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$497.00
|
|
|
IMPLT PLATE 3.5MM 8 HOLE
|
Facility
|
IP
|
$994.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$397.60 |
| Max. Negotiated Rate |
$944.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$795.20
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cigna Commercial |
$844.90
|
| Rate for Payer: First Health Commercial |
$894.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$894.60
|
| Rate for Payer: GEHA Commercial |
$695.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$894.60
|
| Rate for Payer: Multiplan All |
$904.54
|
| Rate for Payer: OMNI Networks Commercial |
$695.80
|
| Rate for Payer: One Health Plan PPO/POS |
$894.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$944.30
|
| Rate for Payer: Three Rivers Provider Network All |
$745.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$924.42
|
| Rate for Payer: Zelis Auto |
$397.60
|
|
|
IMPLT PLATE,3 DEGREE OPEN WEDGE
|
Facility
|
OP
|
$6,684.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,671.00 |
| Max. Negotiated Rate |
$6,349.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,010.40
|
| Rate for Payer: Cash Price |
$4,010.40
|
| Rate for Payer: Cash Price |
$4,010.40
|
| Rate for Payer: Cigna Commercial |
$5,681.40
|
| Rate for Payer: First Health Commercial |
$6,015.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,015.60
|
| Rate for Payer: GEHA Commercial |
$5,347.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,015.60
|
| Rate for Payer: Humana ChoiceCare |
$1,737.84
|
| Rate for Payer: Multiplan All |
$6,082.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,010.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,678.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,015.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,349.80
|
| Rate for Payer: Three Rivers Provider Network All |
$5,013.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,881.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,671.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,216.12
|
| Rate for Payer: Zelis Auto |
$2,673.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,342.00
|
|
|
IMPLT PLATE,3 DEGREE OPEN WEDGE
|
Facility
|
IP
|
$6,684.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.60 |
| Max. Negotiated Rate |
$6,349.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,347.20
|
| Rate for Payer: Cash Price |
$4,010.40
|
| Rate for Payer: Cash Price |
$4,010.40
|
| Rate for Payer: Cigna Commercial |
$5,681.40
|
| Rate for Payer: First Health Commercial |
$6,015.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,015.60
|
| Rate for Payer: GEHA Commercial |
$4,678.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,015.60
|
| Rate for Payer: Multiplan All |
$6,082.44
|
| Rate for Payer: OMNI Networks Commercial |
$4,678.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,015.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,349.80
|
| Rate for Payer: Three Rivers Provider Network All |
$5,013.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,216.12
|
| Rate for Payer: Zelis Auto |
$2,673.60
|
|
|
IMPLT PLATE,3H,LEFT,59MM
|
Facility
|
OP
|
$2,355.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.75 |
| Max. Negotiated Rate |
$2,237.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,413.00
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cigna Commercial |
$2,001.75
|
| Rate for Payer: First Health Commercial |
$2,119.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,119.50
|
| Rate for Payer: GEHA Commercial |
$1,884.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,119.50
|
| Rate for Payer: Humana ChoiceCare |
$612.30
|
| Rate for Payer: Multiplan All |
$2,143.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,413.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,648.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,119.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,237.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,766.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,072.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,190.15
|
| Rate for Payer: Zelis Auto |
$942.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,177.50
|
|
|
IMPLT PLATE,3H,LEFT,59MM
|
Facility
|
IP
|
$2,355.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.00 |
| Max. Negotiated Rate |
$2,237.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,884.00
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cigna Commercial |
$2,001.75
|
| Rate for Payer: First Health Commercial |
$2,119.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,119.50
|
| Rate for Payer: GEHA Commercial |
$1,648.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,119.50
|
| Rate for Payer: Multiplan All |
$2,143.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,648.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,119.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,237.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,766.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,190.15
|
| Rate for Payer: Zelis Auto |
$942.00
|
|
|
IMPLT PLATE,3HOLE,1/3 TUBULAR,37MM
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$406.40
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
|
|
IMPLT PLATE,3HOLE,1/3 TUBULAR,37MM
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$132.08
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$304.80
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$447.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$254.00
|
|
|
IMPLT PLATE 3HOLE LEFT STANDARD
|
Facility
|
OP
|
$3,806.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$951.50 |
| Max. Negotiated Rate |
$3,615.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cigna Commercial |
$3,235.10
|
| Rate for Payer: First Health Commercial |
$3,425.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,425.40
|
| Rate for Payer: GEHA Commercial |
$3,044.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,425.40
|
| Rate for Payer: Humana ChoiceCare |
$989.56
|
| Rate for Payer: Multiplan All |
$3,463.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,283.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,664.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,425.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,615.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,854.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,349.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$951.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,539.58
|
| Rate for Payer: Zelis Auto |
$1,522.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,903.00
|
|
|
IMPLT PLATE 3HOLE LEFT STANDARD
|
Facility
|
IP
|
$3,806.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,522.40 |
| Max. Negotiated Rate |
$3,615.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,044.80
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cigna Commercial |
$3,235.10
|
| Rate for Payer: First Health Commercial |
$3,425.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,425.40
|
| Rate for Payer: GEHA Commercial |
$2,664.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,425.40
|
| Rate for Payer: Multiplan All |
$3,463.46
|
| Rate for Payer: OMNI Networks Commercial |
$2,664.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,425.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,615.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,854.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,539.58
|
| Rate for Payer: Zelis Auto |
$1,522.40
|
|
|
IMPLT PLATE 3 HOLE RIGHT 62MM
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.00 |
| Max. Negotiated Rate |
$2,242.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,888.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cigna Commercial |
$2,006.00
|
| Rate for Payer: First Health Commercial |
$2,124.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,124.00
|
| Rate for Payer: GEHA Commercial |
$1,652.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,124.00
|
| Rate for Payer: Multiplan All |
$2,147.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,652.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,124.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,242.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,770.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,194.80
|
| Rate for Payer: Zelis Auto |
$944.00
|
|
|
IMPLT PLATE 3 HOLE RIGHT 62MM
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.00 |
| Max. Negotiated Rate |
$2,242.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cigna Commercial |
$2,006.00
|
| Rate for Payer: First Health Commercial |
$2,124.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,124.00
|
| Rate for Payer: GEHA Commercial |
$1,888.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,124.00
|
| Rate for Payer: Humana ChoiceCare |
$613.60
|
| Rate for Payer: Multiplan All |
$2,147.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,416.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,652.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,124.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,242.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,770.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,076.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$590.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,194.80
|
| Rate for Payer: Zelis Auto |
$944.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,180.00
|
|
|
IMPLT PLATE 3H RIGHT 59MM
|
Facility
|
OP
|
$2,348.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$587.00 |
| Max. Negotiated Rate |
$2,230.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,408.80
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cigna Commercial |
$1,995.80
|
| Rate for Payer: First Health Commercial |
$2,113.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,113.20
|
| Rate for Payer: GEHA Commercial |
$1,878.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,113.20
|
| Rate for Payer: Humana ChoiceCare |
$610.48
|
| Rate for Payer: Multiplan All |
$2,136.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,408.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,643.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,113.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,230.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,761.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,066.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$587.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,183.64
|
| Rate for Payer: Zelis Auto |
$939.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,174.00
|
|
|
IMPLT PLATE 3H RIGHT 59MM
|
Facility
|
IP
|
$2,348.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.20 |
| Max. Negotiated Rate |
$2,230.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,878.40
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cigna Commercial |
$1,995.80
|
| Rate for Payer: First Health Commercial |
$2,113.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,113.20
|
| Rate for Payer: GEHA Commercial |
$1,643.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,113.20
|
| Rate for Payer: Multiplan All |
$2,136.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,643.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,113.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,230.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,761.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,183.64
|
| Rate for Payer: Zelis Auto |
$939.20
|
|
|
IMPLT PLATE 49MM 8 HOLE VARIAX BN RDS
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002928
|
|
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 49MM 8 HOLE VARIAX BN RDS
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002928
|
|
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 4H LEFT 71MM
|
Facility
|
OP
|
$2,455.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.75 |
| Max. Negotiated Rate |
$2,332.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,473.00
|
| Rate for Payer: Cash Price |
$1,473.00
|
| Rate for Payer: Cash Price |
$1,473.00
|
| Rate for Payer: Cigna Commercial |
$2,086.75
|
| Rate for Payer: First Health Commercial |
$2,209.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,209.50
|
| Rate for Payer: GEHA Commercial |
$1,964.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,209.50
|
| Rate for Payer: Humana ChoiceCare |
$638.30
|
| Rate for Payer: Multiplan All |
$2,234.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,473.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,718.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,209.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,332.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,841.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,160.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$613.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,283.15
|
| Rate for Payer: Zelis Auto |
$982.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,227.50
|
|
|
IMPLT PLATE 4H LEFT 71MM
|
Facility
|
IP
|
$2,455.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.00 |
| Max. Negotiated Rate |
$2,332.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,964.00
|
| Rate for Payer: Cash Price |
$1,473.00
|
| Rate for Payer: Cash Price |
$1,473.00
|
| Rate for Payer: Cigna Commercial |
$2,086.75
|
| Rate for Payer: First Health Commercial |
$2,209.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,209.50
|
| Rate for Payer: GEHA Commercial |
$1,718.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,209.50
|
| Rate for Payer: Multiplan All |
$2,234.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,718.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,209.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,332.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,841.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,283.15
|
| Rate for Payer: Zelis Auto |
$982.00
|
|
|
IMPLT PLATE 4 HOLE
|
Facility
|
IP
|
$6,539.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003095
|
|
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 4 HOLE
|
Facility
|
OP
|
$6,539.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003095
|
|
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
|
|
