|
IMPLT PLATE,6 HOLE ULNA SHORTENING
|
Facility
|
OP
|
$3,697.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$924.25 |
| Max. Negotiated Rate |
$3,512.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,218.20
|
| Rate for Payer: Cash Price |
$2,218.20
|
| Rate for Payer: Cash Price |
$2,218.20
|
| Rate for Payer: Cigna Commercial |
$3,142.45
|
| Rate for Payer: First Health Commercial |
$3,327.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,327.30
|
| Rate for Payer: GEHA Commercial |
$2,957.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,327.30
|
| Rate for Payer: Humana ChoiceCare |
$961.22
|
| Rate for Payer: Multiplan All |
$3,364.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,218.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,587.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,327.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,512.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,772.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,253.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$924.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,438.21
|
| Rate for Payer: Zelis Auto |
$1,478.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,848.50
|
|
|
IMPLT PLATE,6 HOLE ULNA SHORTENING
|
Facility
|
IP
|
$3,697.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,478.80 |
| Max. Negotiated Rate |
$3,512.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,957.60
|
| Rate for Payer: Cash Price |
$2,218.20
|
| Rate for Payer: Cash Price |
$2,218.20
|
| Rate for Payer: Cigna Commercial |
$3,142.45
|
| Rate for Payer: First Health Commercial |
$3,327.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,327.30
|
| Rate for Payer: GEHA Commercial |
$2,587.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,327.30
|
| Rate for Payer: Multiplan All |
$3,364.27
|
| Rate for Payer: OMNI Networks Commercial |
$2,587.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,327.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,512.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,772.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,438.21
|
| Rate for Payer: Zelis Auto |
$1,478.80
|
|
|
IMPLT PLATE,6H,RIGHT,74MM
|
Facility
|
OP
|
$2,258.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000394
|
|
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,6H,RIGHT,74MM
|
Facility
|
IP
|
$2,258.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000394
|
|
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 7HL 81MM
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.20 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,502.40
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$1,596.30
|
| Rate for Payer: First Health Commercial |
$1,690.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.20
|
| Rate for Payer: GEHA Commercial |
$1,314.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.20
|
| Rate for Payer: Multiplan All |
$1,708.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,746.54
|
| Rate for Payer: Zelis Auto |
$751.20
|
|
|
IMPLT PLATE 7HL 81MM
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.50 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$1,596.30
|
| Rate for Payer: First Health Commercial |
$1,690.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.20
|
| Rate for Payer: GEHA Commercial |
$1,502.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.20
|
| Rate for Payer: Humana ChoiceCare |
$488.28
|
| Rate for Payer: Multiplan All |
$1,708.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,126.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,652.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$469.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,746.54
|
| Rate for Payer: Zelis Auto |
$751.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$939.00
|
|
|
IMPLT PLATE,7H,LEFT,107MM
|
Facility
|
IP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,063.60 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,127.20
|
| Rate for Payer: Cash Price |
$1,595.40
|
| Rate for Payer: Cash Price |
$1,595.40
|
| Rate for Payer: Cigna Commercial |
$2,260.15
|
| Rate for Payer: First Health Commercial |
$2,393.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,393.10
|
| Rate for Payer: GEHA Commercial |
$1,861.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,393.10
|
| Rate for Payer: Multiplan All |
$2,419.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,861.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,393.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,526.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,994.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,472.87
|
| Rate for Payer: Zelis Auto |
$1,063.60
|
|
|
IMPLT PLATE,7H,LEFT,107MM
|
Facility
|
OP
|
$2,659.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.75 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,595.40
|
| Rate for Payer: Cash Price |
$1,595.40
|
| Rate for Payer: Cash Price |
$1,595.40
|
| Rate for Payer: Cigna Commercial |
$2,260.15
|
| Rate for Payer: First Health Commercial |
$2,393.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,393.10
|
| Rate for Payer: GEHA Commercial |
$2,127.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,393.10
|
| Rate for Payer: Humana ChoiceCare |
$691.34
|
| Rate for Payer: Multiplan All |
$2,419.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,595.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,861.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,393.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,526.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,994.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,339.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$664.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,472.87
|
| Rate for Payer: Zelis Auto |
$1,063.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,329.50
|
|
|
IMPLT PLATE,7H,LEFT,86MM
|
Facility
|
OP
|
$2,393.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.25 |
| Max. Negotiated Rate |
$2,273.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,435.80
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$2,034.05
|
| Rate for Payer: First Health Commercial |
$2,153.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,153.70
|
| Rate for Payer: GEHA Commercial |
$1,914.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,153.70
|
| Rate for Payer: Humana ChoiceCare |
$622.18
|
| Rate for Payer: Multiplan All |
$2,177.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,435.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,675.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,153.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,273.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,794.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,105.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$598.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,225.49
|
| Rate for Payer: Zelis Auto |
$957.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,196.50
|
|
|
IMPLT PLATE,7H,LEFT,86MM
|
Facility
|
IP
|
$2,393.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.20 |
| Max. Negotiated Rate |
$2,273.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,914.40
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$2,034.05
|
| Rate for Payer: First Health Commercial |
$2,153.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,153.70
|
| Rate for Payer: GEHA Commercial |
$1,675.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,153.70
|
| Rate for Payer: Multiplan All |
$2,177.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,675.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,153.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,273.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,794.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,225.49
|
| Rate for Payer: Zelis Auto |
$957.20
|
|
|
IMPLT PLATE 7 HL SUP VARIAX CLVCL LT LAT
|
Facility
|
OP
|
$3,450.72
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.68 |
| Max. Negotiated Rate |
$3,278.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,070.43
|
| Rate for Payer: Cash Price |
$2,070.43
|
| Rate for Payer: Cash Price |
$2,070.43
|
| Rate for Payer: Cigna Commercial |
$2,933.11
|
| Rate for Payer: First Health Commercial |
$3,105.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,105.65
|
| Rate for Payer: GEHA Commercial |
$2,760.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,105.65
|
| Rate for Payer: Humana ChoiceCare |
$897.19
|
| Rate for Payer: Multiplan All |
$3,140.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,070.43
|
| Rate for Payer: OMNI Networks Commercial |
$2,415.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,105.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,278.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,588.04
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,036.63
|
| Rate for Payer: United Healthcare Managed Medicaid |
$862.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,209.17
|
| Rate for Payer: Zelis Auto |
$1,380.29
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,725.36
|
|
|
IMPLT PLATE 7 HL SUP VARIAX CLVCL LT LAT
|
Facility
|
IP
|
$3,450.72
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.29 |
| Max. Negotiated Rate |
$3,278.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,760.58
|
| Rate for Payer: Cash Price |
$2,070.43
|
| Rate for Payer: Cash Price |
$2,070.43
|
| Rate for Payer: Cigna Commercial |
$2,933.11
|
| Rate for Payer: First Health Commercial |
$3,105.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,105.65
|
| Rate for Payer: GEHA Commercial |
$2,415.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,105.65
|
| Rate for Payer: Multiplan All |
$3,140.16
|
| Rate for Payer: OMNI Networks Commercial |
$2,415.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,105.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,278.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,588.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,209.17
|
| Rate for Payer: Zelis Auto |
$1,380.29
|
|
|
IMPLT PLATE 7 HL SUP VARIAX CLVCL LT LAT
|
Facility
|
IP
|
$4,449.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,779.60 |
| Max. Negotiated Rate |
$4,226.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,559.20
|
| Rate for Payer: Cash Price |
$2,669.40
|
| Rate for Payer: Cash Price |
$2,669.40
|
| Rate for Payer: Cigna Commercial |
$3,781.65
|
| Rate for Payer: First Health Commercial |
$4,004.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,004.10
|
| Rate for Payer: GEHA Commercial |
$3,114.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,004.10
|
| Rate for Payer: Multiplan All |
$4,048.59
|
| Rate for Payer: OMNI Networks Commercial |
$3,114.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,004.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,226.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,336.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,137.57
|
| Rate for Payer: Zelis Auto |
$1,779.60
|
|
|
IMPLT PLATE 7 HL SUP VARIAX CLVCL LT LAT
|
Facility
|
OP
|
$4,449.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,112.25 |
| Max. Negotiated Rate |
$4,226.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,669.40
|
| Rate for Payer: Cash Price |
$2,669.40
|
| Rate for Payer: Cash Price |
$2,669.40
|
| Rate for Payer: Cigna Commercial |
$3,781.65
|
| Rate for Payer: First Health Commercial |
$4,004.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,004.10
|
| Rate for Payer: GEHA Commercial |
$3,559.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,004.10
|
| Rate for Payer: Humana ChoiceCare |
$1,156.74
|
| Rate for Payer: Multiplan All |
$4,048.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,669.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,114.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,004.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,226.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,336.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,915.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,112.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,137.57
|
| Rate for Payer: Zelis Auto |
$1,779.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,224.50
|
|
|
IMPLT PLATE,7 HOLE 1.7MM
|
Facility
|
IP
|
$1,821.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.40 |
| Max. Negotiated Rate |
$1,729.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,456.80
|
| Rate for Payer: Cash Price |
$1,092.60
|
| Rate for Payer: Cash Price |
$1,092.60
|
| Rate for Payer: Cigna Commercial |
$1,547.85
|
| Rate for Payer: First Health Commercial |
$1,638.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,638.90
|
| Rate for Payer: GEHA Commercial |
$1,274.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,638.90
|
| Rate for Payer: Multiplan All |
$1,657.11
|
| Rate for Payer: OMNI Networks Commercial |
$1,274.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,638.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,729.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,365.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,693.53
|
| Rate for Payer: Zelis Auto |
$728.40
|
|
|
IMPLT PLATE,7 HOLE 1.7MM
|
Facility
|
OP
|
$1,821.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.25 |
| Max. Negotiated Rate |
$1,729.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,092.60
|
| Rate for Payer: Cash Price |
$1,092.60
|
| Rate for Payer: Cash Price |
$1,092.60
|
| Rate for Payer: Cigna Commercial |
$1,547.85
|
| Rate for Payer: First Health Commercial |
$1,638.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,638.90
|
| Rate for Payer: GEHA Commercial |
$1,456.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,638.90
|
| Rate for Payer: Humana ChoiceCare |
$473.46
|
| Rate for Payer: Multiplan All |
$1,657.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,092.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,274.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,638.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,729.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,365.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,602.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$455.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,693.53
|
| Rate for Payer: Zelis Auto |
$728.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$910.50
|
|
|
IMPLT PLATE 7HOLE 3.5X106MM
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.00 |
| Max. Negotiated Rate |
$840.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$708.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$752.25
|
| Rate for Payer: First Health Commercial |
$796.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$796.50
|
| Rate for Payer: GEHA Commercial |
$619.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$796.50
|
| Rate for Payer: Multiplan All |
$805.35
|
| Rate for Payer: OMNI Networks Commercial |
$619.50
|
| Rate for Payer: One Health Plan PPO/POS |
$796.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$840.75
|
| Rate for Payer: Three Rivers Provider Network All |
$663.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$823.05
|
| Rate for Payer: Zelis Auto |
$354.00
|
|
|
IMPLT PLATE 7HOLE 3.5X106MM
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$840.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$752.25
|
| Rate for Payer: First Health Commercial |
$796.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$796.50
|
| Rate for Payer: GEHA Commercial |
$708.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$796.50
|
| Rate for Payer: Humana ChoiceCare |
$230.10
|
| Rate for Payer: Multiplan All |
$805.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$531.00
|
| Rate for Payer: OMNI Networks Commercial |
$619.50
|
| Rate for Payer: One Health Plan PPO/POS |
$796.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$840.75
|
| Rate for Payer: Three Rivers Provider Network All |
$663.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$778.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$221.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$823.05
|
| Rate for Payer: Zelis Auto |
$354.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$442.50
|
|
|
IMPLT PLATE 7HOLE MTP LONG
|
Facility
|
IP
|
$6,227.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,490.80 |
| Max. Negotiated Rate |
$5,915.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,981.60
|
| Rate for Payer: Cash Price |
$3,736.20
|
| Rate for Payer: Cash Price |
$3,736.20
|
| Rate for Payer: Cigna Commercial |
$5,292.95
|
| Rate for Payer: First Health Commercial |
$5,604.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,604.30
|
| Rate for Payer: GEHA Commercial |
$4,358.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,604.30
|
| Rate for Payer: Multiplan All |
$5,666.57
|
| Rate for Payer: OMNI Networks Commercial |
$4,358.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,604.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,915.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,670.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,791.11
|
| Rate for Payer: Zelis Auto |
$2,490.80
|
|
|
IMPLT PLATE 7HOLE MTP LONG
|
Facility
|
OP
|
$6,227.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.75 |
| Max. Negotiated Rate |
$5,915.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,736.20
|
| Rate for Payer: Cash Price |
$3,736.20
|
| Rate for Payer: Cash Price |
$3,736.20
|
| Rate for Payer: Cigna Commercial |
$5,292.95
|
| Rate for Payer: First Health Commercial |
$5,604.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,604.30
|
| Rate for Payer: GEHA Commercial |
$4,981.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,604.30
|
| Rate for Payer: Humana ChoiceCare |
$1,619.02
|
| Rate for Payer: Multiplan All |
$5,666.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,736.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,358.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,604.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,915.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,670.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,479.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,556.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,791.11
|
| Rate for Payer: Zelis Auto |
$2,490.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,113.50
|
|
|
IMPLT PLATE 7 HOLE RIGHT
|
Facility
|
IP
|
$4,941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,976.40 |
| Max. Negotiated Rate |
$4,693.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,952.80
|
| Rate for Payer: Cash Price |
$2,964.60
|
| Rate for Payer: Cash Price |
$2,964.60
|
| Rate for Payer: Cigna Commercial |
$4,199.85
|
| Rate for Payer: First Health Commercial |
$4,446.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,446.90
|
| Rate for Payer: GEHA Commercial |
$3,458.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,446.90
|
| Rate for Payer: Multiplan All |
$4,496.31
|
| Rate for Payer: OMNI Networks Commercial |
$3,458.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,446.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,693.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,705.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,595.13
|
| Rate for Payer: Zelis Auto |
$1,976.40
|
|
|
IMPLT PLATE 7 HOLE RIGHT
|
Facility
|
OP
|
$4,941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,235.25 |
| Max. Negotiated Rate |
$4,693.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,964.60
|
| Rate for Payer: Cash Price |
$2,964.60
|
| Rate for Payer: Cash Price |
$2,964.60
|
| Rate for Payer: Cigna Commercial |
$4,199.85
|
| Rate for Payer: First Health Commercial |
$4,446.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,446.90
|
| Rate for Payer: GEHA Commercial |
$3,952.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,446.90
|
| Rate for Payer: Humana ChoiceCare |
$1,284.66
|
| Rate for Payer: Multiplan All |
$4,496.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,964.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,458.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,446.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,693.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,705.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,348.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,235.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,595.13
|
| Rate for Payer: Zelis Auto |
$1,976.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,470.50
|
|
|
IMPLT PLATE 7H RIGHT 107MM
|
Facility
|
IP
|
$3,521.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,408.40 |
| Max. Negotiated Rate |
$3,344.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,816.80
|
| Rate for Payer: Cash Price |
$2,112.60
|
| Rate for Payer: Cash Price |
$2,112.60
|
| Rate for Payer: Cigna Commercial |
$2,992.85
|
| Rate for Payer: First Health Commercial |
$3,168.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,168.90
|
| Rate for Payer: GEHA Commercial |
$2,464.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,168.90
|
| Rate for Payer: Multiplan All |
$3,204.11
|
| Rate for Payer: OMNI Networks Commercial |
$2,464.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,168.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,344.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,640.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,274.53
|
| Rate for Payer: Zelis Auto |
$1,408.40
|
|
|
IMPLT PLATE 7H RIGHT 107MM
|
Facility
|
OP
|
$3,521.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.25 |
| Max. Negotiated Rate |
$3,344.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,112.60
|
| Rate for Payer: Cash Price |
$2,112.60
|
| Rate for Payer: Cash Price |
$2,112.60
|
| Rate for Payer: Cigna Commercial |
$2,992.85
|
| Rate for Payer: First Health Commercial |
$3,168.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,168.90
|
| Rate for Payer: GEHA Commercial |
$2,816.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,168.90
|
| Rate for Payer: Humana ChoiceCare |
$915.46
|
| Rate for Payer: Multiplan All |
$3,204.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,112.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,464.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,168.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,344.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,640.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,098.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$880.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,274.53
|
| Rate for Payer: Zelis Auto |
$1,408.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,760.50
|
|
|
IMPLT PLATE,7H,RIGHT,107MM
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$484.00 |
| Max. Negotiated Rate |
$1,149.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$968.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cigna Commercial |
$1,028.50
|
| Rate for Payer: First Health Commercial |
$1,089.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,089.00
|
| Rate for Payer: GEHA Commercial |
$847.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,089.00
|
| Rate for Payer: Multiplan All |
$1,101.10
|
| Rate for Payer: OMNI Networks Commercial |
$847.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,089.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,149.50
|
| Rate for Payer: Three Rivers Provider Network All |
$907.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,125.30
|
| Rate for Payer: Zelis Auto |
$484.00
|
|
