|
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
|
|
|
IMPLT PLATE 5 HOLE RIGHT 86MM
|
Facility
|
IP
|
$2,284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.60 |
| Max. Negotiated Rate |
$2,169.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,827.20
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cigna Commercial |
$1,941.40
|
| Rate for Payer: First Health Commercial |
$2,055.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,055.60
|
| Rate for Payer: GEHA Commercial |
$1,598.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,055.60
|
| Rate for Payer: Multiplan All |
$2,078.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,055.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,169.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,713.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,124.12
|
| Rate for Payer: Zelis Auto |
$913.60
|
|
|
IMPLT PLATE 5 HOLE RIGHT 86MM
|
Facility
|
OP
|
$2,284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.00 |
| Max. Negotiated Rate |
$2,169.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cigna Commercial |
$1,941.40
|
| Rate for Payer: First Health Commercial |
$2,055.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,055.60
|
| Rate for Payer: GEHA Commercial |
$1,827.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,055.60
|
| Rate for Payer: Humana ChoiceCare |
$593.84
|
| Rate for Payer: Multiplan All |
$2,078.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,370.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,055.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,169.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,713.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,009.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$571.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,124.12
|
| Rate for Payer: Zelis Auto |
$913.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,142.00
|
|
|
IMPLT PLATE 5 HOLE TUBULAR 241.35
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000309
|
|
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 TUBULAR 241.35
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000309
|
|
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,5H,RIGHT,62MM
|
Facility
|
IP
|
$2,087.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$834.80 |
| Max. Negotiated Rate |
$1,982.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,669.60
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cigna Commercial |
$1,773.95
|
| Rate for Payer: First Health Commercial |
$1,878.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,878.30
|
| Rate for Payer: GEHA Commercial |
$1,460.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,878.30
|
| Rate for Payer: Multiplan All |
$1,899.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,460.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,878.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,982.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,565.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,940.91
|
| Rate for Payer: Zelis Auto |
$834.80
|
|
|
IMPLT PLATE,5H,RIGHT,62MM
|
Facility
|
OP
|
$2,087.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.75 |
| Max. Negotiated Rate |
$1,982.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,252.20
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cigna Commercial |
$1,773.95
|
| Rate for Payer: First Health Commercial |
$1,878.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,878.30
|
| Rate for Payer: GEHA Commercial |
$1,669.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,878.30
|
| Rate for Payer: Humana ChoiceCare |
$542.62
|
| Rate for Payer: Multiplan All |
$1,899.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,252.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,460.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,878.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,982.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,565.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,836.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$521.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,940.91
|
| Rate for Payer: Zelis Auto |
$834.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,043.50
|
|
|
IMPLT PLATE,5H,RIGHT,83MM
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$867.00
|
| Rate for Payer: First Health Commercial |
$918.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$918.00
|
| Rate for Payer: GEHA Commercial |
$816.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$918.00
|
| Rate for Payer: Humana ChoiceCare |
$265.20
|
| Rate for Payer: Multiplan All |
$928.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$612.00
|
| Rate for Payer: OMNI Networks Commercial |
$714.00
|
| Rate for Payer: One Health Plan PPO/POS |
$918.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$969.00
|
| Rate for Payer: Three Rivers Provider Network All |
$765.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$897.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$255.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$948.60
|
| Rate for Payer: Zelis Auto |
$408.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$510.00
|
|
|
IMPLT PLATE,5H,RIGHT,83MM
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$816.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$867.00
|
| Rate for Payer: First Health Commercial |
$918.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$918.00
|
| Rate for Payer: GEHA Commercial |
$714.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$918.00
|
| Rate for Payer: Multiplan All |
$928.20
|
| Rate for Payer: OMNI Networks Commercial |
$714.00
|
| Rate for Payer: One Health Plan PPO/POS |
$918.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$969.00
|
| Rate for Payer: Three Rivers Provider Network All |
$765.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$948.60
|
| Rate for Payer: Zelis Auto |
$408.00
|
|
|
IMPLT PLATE,6H,74MM
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.50 |
| Max. Negotiated Rate |
$1,062.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$670.80
|
| Rate for Payer: Cash Price |
$670.80
|
| Rate for Payer: Cash Price |
$670.80
|
| Rate for Payer: Cigna Commercial |
$950.30
|
| Rate for Payer: First Health Commercial |
$1,006.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,006.20
|
| Rate for Payer: GEHA Commercial |
$894.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,006.20
|
| Rate for Payer: Humana ChoiceCare |
$290.68
|
| Rate for Payer: Multiplan All |
$1,017.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$670.80
|
| Rate for Payer: OMNI Networks Commercial |
$782.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,006.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,062.10
|
| Rate for Payer: Three Rivers Provider Network All |
$838.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$983.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,039.74
|
| Rate for Payer: Zelis Auto |
$447.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$559.00
|
|
|
IMPLT PLATE,6H,74MM
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.20 |
| Max. Negotiated Rate |
$1,062.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$894.40
|
| Rate for Payer: Cash Price |
$670.80
|
| Rate for Payer: Cash Price |
$670.80
|
| Rate for Payer: Cigna Commercial |
$950.30
|
| Rate for Payer: First Health Commercial |
$1,006.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,006.20
|
| Rate for Payer: GEHA Commercial |
$782.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,006.20
|
| Rate for Payer: Multiplan All |
$1,017.38
|
| Rate for Payer: OMNI Networks Commercial |
$782.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,006.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,062.10
|
| Rate for Payer: Three Rivers Provider Network All |
$838.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,039.74
|
| Rate for Payer: Zelis Auto |
$447.20
|
|
|
IMPLT PLATE 6H LEFT 74MM
|
Facility
|
IP
|
$2,258.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.20 |
| Max. Negotiated Rate |
$2,145.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,806.40
|
| Rate for Payer: Cash Price |
$1,354.80
|
| Rate for Payer: Cash Price |
$1,354.80
|
| Rate for Payer: Cigna Commercial |
$1,919.30
|
| Rate for Payer: First Health Commercial |
$2,032.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,032.20
|
| Rate for Payer: GEHA Commercial |
$1,580.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,032.20
|
| Rate for Payer: Multiplan All |
$2,054.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,580.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,032.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,145.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,693.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,099.94
|
| Rate for Payer: Zelis Auto |
$903.20
|
|
|
IMPLT PLATE 6H LEFT 74MM
|
Facility
|
OP
|
$2,258.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.50 |
| Max. Negotiated Rate |
$2,145.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,354.80
|
| Rate for Payer: Cash Price |
$1,354.80
|
| Rate for Payer: Cash Price |
$1,354.80
|
| Rate for Payer: Cigna Commercial |
$1,919.30
|
| Rate for Payer: First Health Commercial |
$2,032.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,032.20
|
| Rate for Payer: GEHA Commercial |
$1,806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,032.20
|
| Rate for Payer: Humana ChoiceCare |
$587.08
|
| Rate for Payer: Multiplan All |
$2,054.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,354.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,580.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,032.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,145.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,693.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,987.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$564.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,099.94
|
| Rate for Payer: Zelis Auto |
$903.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,129.00
|
|
|
IMPLT PLATE 6 HOLE 1.2MM
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.00 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,056.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,122.00
|
| Rate for Payer: First Health Commercial |
$1,188.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$924.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: Zelis Auto |
$528.00
|
|
|
IMPLT PLATE 6 HOLE 1.2MM
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,122.00
|
| Rate for Payer: First Health Commercial |
$1,188.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$1,056.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| Rate for Payer: Humana ChoiceCare |
$343.20
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$792.00
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,161.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$330.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: Zelis Auto |
$528.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$660.00
|
|
|
IMPLT PLATE,6 HOLE 1.7MM
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.20 |
| Max. Negotiated Rate |
$1,114.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$938.40
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$997.05
|
| Rate for Payer: First Health Commercial |
$1,055.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,055.70
|
| Rate for Payer: GEHA Commercial |
$821.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,055.70
|
| Rate for Payer: Multiplan All |
$1,067.43
|
| Rate for Payer: OMNI Networks Commercial |
$821.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,055.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,114.35
|
| Rate for Payer: Three Rivers Provider Network All |
$879.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,090.89
|
| Rate for Payer: Zelis Auto |
$469.20
|
|
|
IMPLT PLATE,6 HOLE 1.7MM
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.25 |
| Max. Negotiated Rate |
$1,114.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$703.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$997.05
|
| Rate for Payer: First Health Commercial |
$1,055.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,055.70
|
| Rate for Payer: GEHA Commercial |
$938.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,055.70
|
| Rate for Payer: Humana ChoiceCare |
$304.98
|
| Rate for Payer: Multiplan All |
$1,067.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$703.80
|
| Rate for Payer: OMNI Networks Commercial |
$821.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,055.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,114.35
|
| Rate for Payer: Three Rivers Provider Network All |
$879.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,032.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$293.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,090.89
|
| Rate for Payer: Zelis Auto |
$469.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$586.50
|
|
|
IMPLT PLATE 6 HOLE 1.7MM NARROW T
|
Facility
|
OP
|
$1,667.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.75 |
| Max. Negotiated Rate |
$1,583.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,000.20
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Cigna Commercial |
$1,416.95
|
| Rate for Payer: First Health Commercial |
$1,500.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,500.30
|
| Rate for Payer: GEHA Commercial |
$1,333.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,500.30
|
| Rate for Payer: Humana ChoiceCare |
$433.42
|
| Rate for Payer: Multiplan All |
$1,516.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,000.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,166.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,500.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,583.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,250.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,466.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$416.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,550.31
|
| Rate for Payer: Zelis Auto |
$666.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$833.50
|
|
|
IMPLT PLATE 6 HOLE 1.7MM NARROW T
|
Facility
|
IP
|
$1,667.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.80 |
| Max. Negotiated Rate |
$1,583.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,333.60
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Cigna Commercial |
$1,416.95
|
| Rate for Payer: First Health Commercial |
$1,500.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,500.30
|
| Rate for Payer: GEHA Commercial |
$1,166.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,500.30
|
| Rate for Payer: Multiplan All |
$1,516.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,166.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,500.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,583.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,250.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,550.31
|
| Rate for Payer: Zelis Auto |
$666.80
|
|
|
IMPLT PLATE,6HOLE,3.5X93MM
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.25 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$682.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Humana ChoiceCare |
$221.78
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$511.80
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$750.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$426.50
|
|
|
IMPLT PLATE,6HOLE,3.5X93MM
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.20 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$682.40
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$597.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: Zelis Auto |
$341.20
|
|
|
IMPLT PLATE 6 HOLE 4935-006-03
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.75 |
| Max. Negotiated Rate |
$405.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$256.20
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cigna Commercial |
$362.95
|
| Rate for Payer: First Health Commercial |
$384.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$384.30
|
| Rate for Payer: GEHA Commercial |
$341.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$384.30
|
| Rate for Payer: Humana ChoiceCare |
$111.02
|
| Rate for Payer: Multiplan All |
$388.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$256.20
|
| Rate for Payer: OMNI Networks Commercial |
$298.90
|
| Rate for Payer: One Health Plan PPO/POS |
$384.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$405.65
|
| Rate for Payer: Three Rivers Provider Network All |
$320.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$375.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$397.11
|
| Rate for Payer: Zelis Auto |
$170.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$213.50
|
|
|
IMPLT PLATE 6 HOLE 4935-006-03
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$405.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$341.60
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cigna Commercial |
$362.95
|
| Rate for Payer: First Health Commercial |
$384.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$384.30
|
| Rate for Payer: GEHA Commercial |
$298.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$384.30
|
| Rate for Payer: Multiplan All |
$388.57
|
| Rate for Payer: OMNI Networks Commercial |
$298.90
|
| Rate for Payer: One Health Plan PPO/POS |
$384.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$405.65
|
| Rate for Payer: Three Rivers Provider Network All |
$320.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$397.11
|
| Rate for Payer: Zelis Auto |
$170.80
|
|
|
IMPLT PLATE,6HOLE,85MM,RIGHT SIDE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$60.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$63.75
|
| Rate for Payer: First Health Commercial |
$67.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$67.50
|
| Rate for Payer: GEHA Commercial |
$52.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$67.50
|
| Rate for Payer: Multiplan All |
$68.25
|
| Rate for Payer: OMNI Networks Commercial |
$52.50
|
| Rate for Payer: One Health Plan PPO/POS |
$67.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$71.25
|
| Rate for Payer: Three Rivers Provider Network All |
$56.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$69.75
|
| Rate for Payer: Zelis Auto |
$30.00
|
|
|
IMPLT PLATE,6HOLE,85MM,RIGHT SIDE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$63.75
|
| Rate for Payer: First Health Commercial |
$67.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$67.50
|
| Rate for Payer: GEHA Commercial |
$60.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$67.50
|
| Rate for Payer: Humana ChoiceCare |
$19.50
|
| Rate for Payer: Multiplan All |
$68.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$45.00
|
| Rate for Payer: OMNI Networks Commercial |
$52.50
|
| Rate for Payer: One Health Plan PPO/POS |
$67.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$71.25
|
| Rate for Payer: Three Rivers Provider Network All |
$56.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$69.75
|
| Rate for Payer: Zelis Auto |
$30.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$37.50
|
|
