|
IMPLT PLATE 4-HOLE
|
Facility
|
IP
|
$5,148.72
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,059.49 |
| Max. Negotiated Rate |
$4,891.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,118.98
|
| Rate for Payer: Cash Price |
$3,089.23
|
| Rate for Payer: Cash Price |
$3,089.23
|
| Rate for Payer: Cigna Commercial |
$4,376.41
|
| Rate for Payer: First Health Commercial |
$4,633.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,633.85
|
| Rate for Payer: GEHA Commercial |
$3,604.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,633.85
|
| Rate for Payer: Multiplan All |
$4,685.34
|
| Rate for Payer: OMNI Networks Commercial |
$3,604.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,633.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,891.28
|
| Rate for Payer: Three Rivers Provider Network All |
$3,861.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,788.31
|
| Rate for Payer: Zelis Auto |
$2,059.49
|
|
|
IMPLT PLATE 4-HOLE
|
Facility
|
OP
|
$5,148.72
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.18 |
| Max. Negotiated Rate |
$4,891.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,089.23
|
| Rate for Payer: Cash Price |
$3,089.23
|
| Rate for Payer: Cash Price |
$3,089.23
|
| Rate for Payer: Cigna Commercial |
$4,376.41
|
| Rate for Payer: First Health Commercial |
$4,633.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,633.85
|
| Rate for Payer: GEHA Commercial |
$4,118.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,633.85
|
| Rate for Payer: Humana ChoiceCare |
$1,338.67
|
| Rate for Payer: Multiplan All |
$4,685.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,089.23
|
| Rate for Payer: OMNI Networks Commercial |
$3,604.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,633.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,891.28
|
| Rate for Payer: Three Rivers Provider Network All |
$3,861.54
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,530.87
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,287.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,788.31
|
| Rate for Payer: Zelis Auto |
$2,059.49
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,574.36
|
|
|
IMPLT PLATE 4HOLE
|
Facility
|
OP
|
$2,432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.00 |
| Max. Negotiated Rate |
$2,310.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,459.20
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cigna Commercial |
$2,067.20
|
| Rate for Payer: First Health Commercial |
$2,188.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,188.80
|
| Rate for Payer: GEHA Commercial |
$1,945.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,188.80
|
| Rate for Payer: Humana ChoiceCare |
$632.32
|
| Rate for Payer: Multiplan All |
$2,213.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,459.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,702.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,188.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,310.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,824.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,140.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$608.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,261.76
|
| Rate for Payer: Zelis Auto |
$972.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,216.00
|
|
|
IMPLT PLATE 4HOLE
|
Facility
|
IP
|
$2,432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.80 |
| Max. Negotiated Rate |
$2,310.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,945.60
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cigna Commercial |
$2,067.20
|
| Rate for Payer: First Health Commercial |
$2,188.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,188.80
|
| Rate for Payer: GEHA Commercial |
$1,702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,188.80
|
| Rate for Payer: Multiplan All |
$2,213.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,702.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,188.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,310.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,824.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,261.76
|
| Rate for Payer: Zelis Auto |
$972.80
|
|
|
IMPLT PLATE,4H,RIGHT,71MM
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$2,325.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,468.80
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Cigna Commercial |
$2,080.80
|
| Rate for Payer: First Health Commercial |
$2,203.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,203.20
|
| Rate for Payer: GEHA Commercial |
$1,958.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,203.20
|
| Rate for Payer: Humana ChoiceCare |
$636.48
|
| Rate for Payer: Multiplan All |
$2,227.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,468.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,713.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,203.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,325.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,836.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,154.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$612.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,276.64
|
| Rate for Payer: Zelis Auto |
$979.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,224.00
|
|
|
IMPLT PLATE,4H,RIGHT,71MM
|
Facility
|
IP
|
$2,448.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.20 |
| Max. Negotiated Rate |
$2,325.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Cigna Commercial |
$2,080.80
|
| Rate for Payer: First Health Commercial |
$2,203.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,203.20
|
| Rate for Payer: GEHA Commercial |
$1,713.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,203.20
|
| Rate for Payer: Multiplan All |
$2,227.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,713.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,203.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,325.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,836.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,276.64
|
| Rate for Payer: Zelis Auto |
$979.20
|
|
|
IMPLT PLATE 5 HOLE
|
Facility
|
OP
|
$2,293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.25 |
| Max. Negotiated Rate |
$2,178.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,375.80
|
| Rate for Payer: Cash Price |
$1,375.80
|
| Rate for Payer: Cash Price |
$1,375.80
|
| Rate for Payer: Cigna Commercial |
$1,949.05
|
| Rate for Payer: First Health Commercial |
$2,063.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,063.70
|
| Rate for Payer: GEHA Commercial |
$1,834.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,063.70
|
| Rate for Payer: Humana ChoiceCare |
$596.18
|
| Rate for Payer: Multiplan All |
$2,086.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,375.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,605.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,063.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,178.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,719.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,017.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$573.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,132.49
|
| Rate for Payer: Zelis Auto |
$917.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,146.50
|
|
|
IMPLT PLATE 5 HOLE
|
Facility
|
IP
|
$2,293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$917.20 |
| Max. Negotiated Rate |
$2,178.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,834.40
|
| Rate for Payer: Cash Price |
$1,375.80
|
| Rate for Payer: Cash Price |
$1,375.80
|
| Rate for Payer: Cigna Commercial |
$1,949.05
|
| Rate for Payer: First Health Commercial |
$2,063.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,063.70
|
| Rate for Payer: GEHA Commercial |
$1,605.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,063.70
|
| Rate for Payer: Multiplan All |
$2,086.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,605.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,063.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,178.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,719.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,132.49
|
| Rate for Payer: Zelis Auto |
$917.20
|
|
|
IMPLT PLATE 5-HOLE
|
Facility
|
OP
|
$5,390.58
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,347.64 |
| Max. Negotiated Rate |
$5,121.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,234.35
|
| Rate for Payer: Cash Price |
$3,234.35
|
| Rate for Payer: Cash Price |
$3,234.35
|
| Rate for Payer: Cigna Commercial |
$4,581.99
|
| Rate for Payer: First Health Commercial |
$4,851.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,851.52
|
| Rate for Payer: GEHA Commercial |
$4,312.46
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,851.52
|
| Rate for Payer: Humana ChoiceCare |
$1,401.55
|
| Rate for Payer: Multiplan All |
$4,905.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,234.35
|
| Rate for Payer: OMNI Networks Commercial |
$3,773.41
|
| Rate for Payer: One Health Plan PPO/POS |
$4,851.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,121.05
|
| Rate for Payer: Three Rivers Provider Network All |
$4,042.93
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,743.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,347.64
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,013.24
|
| Rate for Payer: Zelis Auto |
$2,156.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,695.29
|
|
|
IMPLT PLATE 5-HOLE
|
Facility
|
IP
|
$5,390.58
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.23 |
| Max. Negotiated Rate |
$5,121.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,312.46
|
| Rate for Payer: Cash Price |
$3,234.35
|
| Rate for Payer: Cash Price |
$3,234.35
|
| Rate for Payer: Cigna Commercial |
$4,581.99
|
| Rate for Payer: First Health Commercial |
$4,851.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,851.52
|
| Rate for Payer: GEHA Commercial |
$3,773.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,851.52
|
| Rate for Payer: Multiplan All |
$4,905.43
|
| Rate for Payer: OMNI Networks Commercial |
$3,773.41
|
| Rate for Payer: One Health Plan PPO/POS |
$4,851.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,121.05
|
| Rate for Payer: Three Rivers Provider Network All |
$4,042.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,013.24
|
| Rate for Payer: Zelis Auto |
$2,156.23
|
|
|
IMPLT PLATE 5 HOLE 1/3 TUBULAR 61MM
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$444.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$388.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| Rate for Payer: Multiplan All |
$505.05
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$527.25
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$516.15
|
| Rate for Payer: Zelis Auto |
$222.00
|
|
|
IMPLT PLATE 5 HOLE 1/3 TUBULAR 61MM
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$444.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| Rate for Payer: Humana ChoiceCare |
$144.30
|
| Rate for Payer: Multiplan All |
$505.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$333.00
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$527.25
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$488.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$138.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$516.15
|
| Rate for Payer: Zelis Auto |
$222.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.50
|
|
|
IMPLT PLATE 5 HOLE 2.0 STRAIGHT 29MM
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$465.80
|
| Rate for Payer: First Health Commercial |
$493.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.20
|
| Rate for Payer: GEHA Commercial |
$438.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.20
|
| Rate for Payer: Humana ChoiceCare |
$142.48
|
| Rate for Payer: Multiplan All |
$498.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$328.80
|
| Rate for Payer: OMNI Networks Commercial |
$383.60
|
| Rate for Payer: One Health Plan PPO/POS |
$493.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$520.60
|
| Rate for Payer: Three Rivers Provider Network All |
$411.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$482.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$509.64
|
| Rate for Payer: Zelis Auto |
$219.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$274.00
|
|
|
IMPLT PLATE 5 HOLE 2.0 STRAIGHT 29MM
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$438.40
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$465.80
|
| Rate for Payer: First Health Commercial |
$493.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.20
|
| Rate for Payer: GEHA Commercial |
$383.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.20
|
| Rate for Payer: Multiplan All |
$498.68
|
| Rate for Payer: OMNI Networks Commercial |
$383.60
|
| Rate for Payer: One Health Plan PPO/POS |
$493.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$520.60
|
| Rate for Payer: Three Rivers Provider Network All |
$411.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$509.64
|
| Rate for Payer: Zelis Auto |
$219.20
|
|
|
IMPLT PLATE,5 HOLE 3.5X70MM 5 HOLE
|
Facility
|
IP
|
$2,789.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.60 |
| Max. Negotiated Rate |
$2,649.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,231.20
|
| Rate for Payer: Cash Price |
$1,673.40
|
| Rate for Payer: Cash Price |
$1,673.40
|
| Rate for Payer: Cigna Commercial |
$2,370.65
|
| Rate for Payer: First Health Commercial |
$2,510.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,510.10
|
| Rate for Payer: GEHA Commercial |
$1,952.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,510.10
|
| Rate for Payer: Multiplan All |
$2,537.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,952.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,510.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,649.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,091.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,593.77
|
| Rate for Payer: Zelis Auto |
$1,115.60
|
|
|
IMPLT PLATE,5 HOLE 3.5X70MM 5 HOLE
|
Facility
|
OP
|
$2,789.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.25 |
| Max. Negotiated Rate |
$2,649.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,673.40
|
| Rate for Payer: Cash Price |
$1,673.40
|
| Rate for Payer: Cash Price |
$1,673.40
|
| Rate for Payer: Cigna Commercial |
$2,370.65
|
| Rate for Payer: First Health Commercial |
$2,510.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,510.10
|
| Rate for Payer: GEHA Commercial |
$2,231.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,510.10
|
| Rate for Payer: Humana ChoiceCare |
$725.14
|
| Rate for Payer: Multiplan All |
$2,537.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,673.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,952.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,510.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,649.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,091.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,454.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$697.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,593.77
|
| Rate for Payer: Zelis Auto |
$1,115.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,394.50
|
|
|
IMPLT PLATE,5 HOLE,72MM
|
Facility
|
OP
|
$2,690.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.50 |
| Max. Negotiated Rate |
$2,555.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,614.00
|
| Rate for Payer: Cash Price |
$1,614.00
|
| Rate for Payer: Cash Price |
$1,614.00
|
| Rate for Payer: Cigna Commercial |
$2,286.50
|
| Rate for Payer: First Health Commercial |
$2,421.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,421.00
|
| Rate for Payer: GEHA Commercial |
$2,152.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,421.00
|
| Rate for Payer: Humana ChoiceCare |
$699.40
|
| Rate for Payer: Multiplan All |
$2,447.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,614.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,883.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,421.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,555.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,017.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,367.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$672.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,501.70
|
| Rate for Payer: Zelis Auto |
$1,076.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,345.00
|
|
|
IMPLT PLATE,5 HOLE,72MM
|
Facility
|
IP
|
$2,690.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.00 |
| Max. Negotiated Rate |
$2,555.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,152.00
|
| Rate for Payer: Cash Price |
$1,614.00
|
| Rate for Payer: Cash Price |
$1,614.00
|
| Rate for Payer: Cigna Commercial |
$2,286.50
|
| Rate for Payer: First Health Commercial |
$2,421.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,421.00
|
| Rate for Payer: GEHA Commercial |
$1,883.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,421.00
|
| Rate for Payer: Multiplan All |
$2,447.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,883.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,421.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,555.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,017.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,501.70
|
| Rate for Payer: Zelis Auto |
$1,076.00
|
|
|
IMPLT PLATE,5 HOLE LEFT 1.5MM
|
Facility
|
OP
|
$2,629.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.25 |
| Max. Negotiated Rate |
$2,497.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,577.40
|
| Rate for Payer: Cash Price |
$1,577.40
|
| Rate for Payer: Cash Price |
$1,577.40
|
| Rate for Payer: Cigna Commercial |
$2,234.65
|
| Rate for Payer: First Health Commercial |
$2,366.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,366.10
|
| Rate for Payer: GEHA Commercial |
$2,103.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,366.10
|
| Rate for Payer: Humana ChoiceCare |
$683.54
|
| Rate for Payer: Multiplan All |
$2,392.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,577.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,840.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,366.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,497.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,971.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,313.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$657.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,444.97
|
| Rate for Payer: Zelis Auto |
$1,051.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,314.50
|
|
|
IMPLT PLATE,5 HOLE LEFT 1.5MM
|
Facility
|
IP
|
$2,629.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.60 |
| Max. Negotiated Rate |
$2,497.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,103.20
|
| Rate for Payer: Cash Price |
$1,577.40
|
| Rate for Payer: Cash Price |
$1,577.40
|
| Rate for Payer: Cigna Commercial |
$2,234.65
|
| Rate for Payer: First Health Commercial |
$2,366.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,366.10
|
| Rate for Payer: GEHA Commercial |
$1,840.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,366.10
|
| Rate for Payer: Multiplan All |
$2,392.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,840.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,366.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,497.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,971.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,444.97
|
| Rate for Payer: Zelis Auto |
$1,051.60
|
|
|
IMPLT PLATE, 5 HOLE LEFT,3.5X83MM
|
Facility
|
OP
|
$2,649.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.25 |
| Max. Negotiated Rate |
$2,516.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,589.40
|
| Rate for Payer: Cash Price |
$1,589.40
|
| Rate for Payer: Cash Price |
$1,589.40
|
| Rate for Payer: Cigna Commercial |
$2,251.65
|
| Rate for Payer: First Health Commercial |
$2,384.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,384.10
|
| Rate for Payer: GEHA Commercial |
$2,119.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,384.10
|
| Rate for Payer: Humana ChoiceCare |
$688.74
|
| Rate for Payer: Multiplan All |
$2,410.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,589.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,854.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,384.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,516.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,986.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,331.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$662.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,463.57
|
| Rate for Payer: Zelis Auto |
$1,059.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,324.50
|
|
|
IMPLT PLATE, 5 HOLE LEFT,3.5X83MM
|
Facility
|
IP
|
$2,649.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.60 |
| Max. Negotiated Rate |
$2,516.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,119.20
|
| Rate for Payer: Cash Price |
$1,589.40
|
| Rate for Payer: Cash Price |
$1,589.40
|
| Rate for Payer: Cigna Commercial |
$2,251.65
|
| Rate for Payer: First Health Commercial |
$2,384.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,384.10
|
| Rate for Payer: GEHA Commercial |
$1,854.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,384.10
|
| Rate for Payer: Multiplan All |
$2,410.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,854.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,384.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,516.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,986.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,463.57
|
| Rate for Payer: Zelis Auto |
$1,059.60
|
|
|
IMPLT PLATE,5HOLE,LOCKING,86MM
|
Facility
|
OP
|
$2,961.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.25 |
| Max. Negotiated Rate |
$2,812.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,776.60
|
| Rate for Payer: Cash Price |
$1,776.60
|
| Rate for Payer: Cash Price |
$1,776.60
|
| Rate for Payer: Cigna Commercial |
$2,516.85
|
| Rate for Payer: First Health Commercial |
$2,664.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,664.90
|
| Rate for Payer: GEHA Commercial |
$2,368.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,664.90
|
| Rate for Payer: Humana ChoiceCare |
$769.86
|
| Rate for Payer: Multiplan All |
$2,694.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,776.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,072.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,664.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,812.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,220.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,605.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$740.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,753.73
|
| Rate for Payer: Zelis Auto |
$1,184.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,480.50
|
|
|
IMPLT PLATE,5HOLE,LOCKING,86MM
|
Facility
|
IP
|
$2,961.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,184.40 |
| Max. Negotiated Rate |
$2,812.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,368.80
|
| Rate for Payer: Cash Price |
$1,776.60
|
| Rate for Payer: Cash Price |
$1,776.60
|
| Rate for Payer: Cigna Commercial |
$2,516.85
|
| Rate for Payer: First Health Commercial |
$2,664.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,664.90
|
| Rate for Payer: GEHA Commercial |
$2,072.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,664.90
|
| Rate for Payer: Multiplan All |
$2,694.51
|
| Rate for Payer: OMNI Networks Commercial |
$2,072.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,664.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,812.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,220.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,753.73
|
| Rate for Payer: Zelis Auto |
$1,184.40
|
|
|
IMPLT PLATE 5 HOLE RIGHT
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$3,564.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cigna Commercial |
$3,189.20
|
| Rate for Payer: First Health Commercial |
$3,376.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,376.80
|
| Rate for Payer: GEHA Commercial |
$3,001.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,376.80
|
| Rate for Payer: Humana ChoiceCare |
$975.52
|
| Rate for Payer: Multiplan All |
$3,414.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,251.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,626.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,376.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,564.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,814.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,301.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$938.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,489.36
|
| Rate for Payer: Zelis Auto |
$1,500.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,876.00
|
|
