|
IMPLT PLATE,7H,RIGHT,107MM
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$302.50 |
| Max. Negotiated Rate |
$1,149.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$726.00
|
| 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 |
$968.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,089.00
|
| Rate for Payer: Humana ChoiceCare |
$314.60
|
| Rate for Payer: Multiplan All |
$1,101.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$726.00
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,064.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$302.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,125.30
|
| Rate for Payer: Zelis Auto |
$484.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$605.00
|
|
|
IMPLT PLATE,7H,RIGHT,86MM
|
Facility
|
OP
|
$2,393.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000401
|
|
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,RIGHT,86MM
|
Facility
|
IP
|
$2,393.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000401
|
|
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 85MM 7HOLE TUBLAR
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$422.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$369.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
|
|
IMPLT PLATE 85MM 7HOLE TUBLAR
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$422.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Humana ChoiceCare |
$137.28
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$316.80
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$464.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$132.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.00
|
|
|
IMPLT PLATE 8HL 61MM EVOS S-T
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007017
|
|
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 8HL 61MM EVOS S-T
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007017
|
|
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 8 HOLE
|
Facility
|
OP
|
$2,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.50 |
| Max. Negotiated Rate |
$2,281.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,441.20
|
| Rate for Payer: Cash Price |
$1,441.20
|
| Rate for Payer: Cash Price |
$1,441.20
|
| Rate for Payer: Cigna Commercial |
$2,041.70
|
| Rate for Payer: First Health Commercial |
$2,161.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,161.80
|
| Rate for Payer: GEHA Commercial |
$1,921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,161.80
|
| Rate for Payer: Humana ChoiceCare |
$624.52
|
| Rate for Payer: Multiplan All |
$2,185.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,441.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,681.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,161.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,281.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,801.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,113.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$600.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,233.86
|
| Rate for Payer: Zelis Auto |
$960.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,201.00
|
|
|
IMPLT PLATE 8 HOLE
|
Facility
|
IP
|
$2,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.80 |
| Max. Negotiated Rate |
$2,281.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,921.60
|
| Rate for Payer: Cash Price |
$1,441.20
|
| Rate for Payer: Cash Price |
$1,441.20
|
| Rate for Payer: Cigna Commercial |
$2,041.70
|
| Rate for Payer: First Health Commercial |
$2,161.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,161.80
|
| Rate for Payer: GEHA Commercial |
$1,681.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,161.80
|
| Rate for Payer: Multiplan All |
$2,185.82
|
| Rate for Payer: OMNI Networks Commercial |
$1,681.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,161.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,281.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,801.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,233.86
|
| Rate for Payer: Zelis Auto |
$960.80
|
|
|
IMPLT PLATE, 8 HOLE
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.25 |
| Max. Negotiated Rate |
$935.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$837.25
|
| Rate for Payer: First Health Commercial |
$886.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$886.50
|
| Rate for Payer: GEHA Commercial |
$788.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$886.50
|
| Rate for Payer: Humana ChoiceCare |
$256.10
|
| Rate for Payer: Multiplan All |
$896.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$591.00
|
| Rate for Payer: OMNI Networks Commercial |
$689.50
|
| Rate for Payer: One Health Plan PPO/POS |
$886.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$935.75
|
| Rate for Payer: Three Rivers Provider Network All |
$738.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$866.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$916.05
|
| Rate for Payer: Zelis Auto |
$394.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$492.50
|
|
|
IMPLT PLATE, 8 HOLE
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.00 |
| Max. Negotiated Rate |
$935.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$788.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$837.25
|
| Rate for Payer: First Health Commercial |
$886.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$886.50
|
| Rate for Payer: GEHA Commercial |
$689.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$886.50
|
| Rate for Payer: Multiplan All |
$896.35
|
| Rate for Payer: OMNI Networks Commercial |
$689.50
|
| Rate for Payer: One Health Plan PPO/POS |
$886.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$935.75
|
| Rate for Payer: Three Rivers Provider Network All |
$738.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$916.05
|
| Rate for Payer: Zelis Auto |
$394.00
|
|
|
IMPLT PLATE 8 HOLE 4935-008-03
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$353.60
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$309.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: Zelis Auto |
$176.80
|
|
|
IMPLT PLATE 8 HOLE 4935-008-03
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$353.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Humana ChoiceCare |
$114.92
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$265.20
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$388.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$221.00
|
|
|
IMPLT PLATE 8HOLE FUSION
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$46.40
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$49.30
|
| Rate for Payer: First Health Commercial |
$52.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$52.20
|
| Rate for Payer: GEHA Commercial |
$40.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$52.20
|
| Rate for Payer: Multiplan All |
$52.78
|
| Rate for Payer: OMNI Networks Commercial |
$40.60
|
| Rate for Payer: One Health Plan PPO/POS |
$52.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$55.10
|
| Rate for Payer: Three Rivers Provider Network All |
$43.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.94
|
| Rate for Payer: Zelis Auto |
$23.20
|
|
|
IMPLT PLATE 8HOLE FUSION
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$49.30
|
| Rate for Payer: First Health Commercial |
$52.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$52.20
|
| Rate for Payer: GEHA Commercial |
$46.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$52.20
|
| Rate for Payer: Humana ChoiceCare |
$15.08
|
| Rate for Payer: Multiplan All |
$52.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.80
|
| Rate for Payer: OMNI Networks Commercial |
$40.60
|
| Rate for Payer: One Health Plan PPO/POS |
$52.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$55.10
|
| Rate for Payer: Three Rivers Provider Network All |
$43.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$51.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.94
|
| Rate for Payer: Zelis Auto |
$23.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$29.00
|
|
|
IMPLT PLATE 95MM TI 2 HOLE TIBIA RT PROX
|
Facility
|
OP
|
$6,419.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.75 |
| Max. Negotiated Rate |
$6,098.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,851.40
|
| Rate for Payer: Cash Price |
$3,851.40
|
| Rate for Payer: Cash Price |
$3,851.40
|
| Rate for Payer: Cigna Commercial |
$5,456.15
|
| Rate for Payer: First Health Commercial |
$5,777.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,777.10
|
| Rate for Payer: GEHA Commercial |
$5,135.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,777.10
|
| Rate for Payer: Humana ChoiceCare |
$1,668.94
|
| Rate for Payer: Multiplan All |
$5,841.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,851.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,493.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,777.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,098.05
|
| Rate for Payer: Three Rivers Provider Network All |
$4,814.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,648.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,604.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,969.67
|
| Rate for Payer: Zelis Auto |
$2,567.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,209.50
|
|
|
IMPLT PLATE 95MM TI 2 HOLE TIBIA RT PROX
|
Facility
|
IP
|
$6,419.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.60 |
| Max. Negotiated Rate |
$6,098.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,135.20
|
| Rate for Payer: Cash Price |
$3,851.40
|
| Rate for Payer: Cash Price |
$3,851.40
|
| Rate for Payer: Cigna Commercial |
$5,456.15
|
| Rate for Payer: First Health Commercial |
$5,777.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,777.10
|
| Rate for Payer: GEHA Commercial |
$4,493.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,777.10
|
| Rate for Payer: Multiplan All |
$5,841.29
|
| Rate for Payer: OMNI Networks Commercial |
$4,493.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,777.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,098.05
|
| Rate for Payer: Three Rivers Provider Network All |
$4,814.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,969.67
|
| Rate for Payer: Zelis Auto |
$2,567.60
|
|
|
IMPLT PLATE,9H,LEFT,131MM
|
Facility
|
OP
|
$2,759.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$689.75 |
| Max. Negotiated Rate |
$2,621.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,655.40
|
| Rate for Payer: Cash Price |
$1,655.40
|
| Rate for Payer: Cash Price |
$1,655.40
|
| Rate for Payer: Cigna Commercial |
$2,345.15
|
| Rate for Payer: First Health Commercial |
$2,483.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,483.10
|
| Rate for Payer: GEHA Commercial |
$2,207.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,483.10
|
| Rate for Payer: Humana ChoiceCare |
$717.34
|
| Rate for Payer: Multiplan All |
$2,510.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,655.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,931.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,483.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,621.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,069.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,427.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$689.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,565.87
|
| Rate for Payer: Zelis Auto |
$1,103.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,379.50
|
|
|
IMPLT PLATE,9H,LEFT,131MM
|
Facility
|
IP
|
$2,759.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,103.60 |
| Max. Negotiated Rate |
$2,621.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,207.20
|
| Rate for Payer: Cash Price |
$1,655.40
|
| Rate for Payer: Cash Price |
$1,655.40
|
| Rate for Payer: Cigna Commercial |
$2,345.15
|
| Rate for Payer: First Health Commercial |
$2,483.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,483.10
|
| Rate for Payer: GEHA Commercial |
$1,931.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,483.10
|
| Rate for Payer: Multiplan All |
$2,510.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,931.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,483.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,621.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,069.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,565.87
|
| Rate for Payer: Zelis Auto |
$1,103.60
|
|
|
IMPLT PLATE 9 HOLE 4.5X169MM
|
Facility
|
OP
|
$5,856.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.00 |
| Max. Negotiated Rate |
$5,563.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,513.60
|
| Rate for Payer: Cash Price |
$3,513.60
|
| Rate for Payer: Cash Price |
$3,513.60
|
| Rate for Payer: Cigna Commercial |
$4,977.60
|
| Rate for Payer: First Health Commercial |
$5,270.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,270.40
|
| Rate for Payer: GEHA Commercial |
$4,684.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,270.40
|
| Rate for Payer: Humana ChoiceCare |
$1,522.56
|
| Rate for Payer: Multiplan All |
$5,328.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,513.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,099.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,270.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,563.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,392.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,153.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,464.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,446.08
|
| Rate for Payer: Zelis Auto |
$2,342.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,928.00
|
|
|
IMPLT PLATE 9 HOLE 4.5X169MM
|
Facility
|
IP
|
$5,856.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.40 |
| Max. Negotiated Rate |
$5,563.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,684.80
|
| Rate for Payer: Cash Price |
$3,513.60
|
| Rate for Payer: Cash Price |
$3,513.60
|
| Rate for Payer: Cigna Commercial |
$4,977.60
|
| Rate for Payer: First Health Commercial |
$5,270.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,270.40
|
| Rate for Payer: GEHA Commercial |
$4,099.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,270.40
|
| Rate for Payer: Multiplan All |
$5,328.96
|
| Rate for Payer: OMNI Networks Commercial |
$4,099.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,270.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,563.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,392.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,446.08
|
| Rate for Payer: Zelis Auto |
$2,342.40
|
|
|
IMPLT PLATE,9 HOLE,NARROW
|
Facility
|
OP
|
$2,172.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$2,063.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cigna Commercial |
$1,846.20
|
| Rate for Payer: First Health Commercial |
$1,954.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,954.80
|
| Rate for Payer: GEHA Commercial |
$1,737.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,954.80
|
| Rate for Payer: Humana ChoiceCare |
$564.72
|
| Rate for Payer: Multiplan All |
$1,976.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,303.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,520.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,954.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,063.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,629.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,911.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$543.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,019.96
|
| Rate for Payer: Zelis Auto |
$868.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,086.00
|
|
|
IMPLT PLATE,9 HOLE,NARROW
|
Facility
|
IP
|
$2,172.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.80 |
| Max. Negotiated Rate |
$2,063.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,737.60
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cigna Commercial |
$1,846.20
|
| Rate for Payer: First Health Commercial |
$1,954.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,954.80
|
| Rate for Payer: GEHA Commercial |
$1,520.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,954.80
|
| Rate for Payer: Multiplan All |
$1,976.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,520.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,954.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,063.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,629.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,019.96
|
| Rate for Payer: Zelis Auto |
$868.80
|
|
|
IMPLT PLATE,9 HOLE,RIGHT
|
Facility
|
OP
|
$2,747.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.75 |
| Max. Negotiated Rate |
$2,609.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,648.20
|
| Rate for Payer: Cash Price |
$1,648.20
|
| Rate for Payer: Cash Price |
$1,648.20
|
| Rate for Payer: Cigna Commercial |
$2,334.95
|
| Rate for Payer: First Health Commercial |
$2,472.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,472.30
|
| Rate for Payer: GEHA Commercial |
$2,197.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,472.30
|
| Rate for Payer: Humana ChoiceCare |
$714.22
|
| Rate for Payer: Multiplan All |
$2,499.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,648.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,922.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,472.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,609.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,060.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,417.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$686.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,554.71
|
| Rate for Payer: Zelis Auto |
$1,098.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,373.50
|
|
|
IMPLT PLATE,9 HOLE,RIGHT
|
Facility
|
IP
|
$2,747.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.80 |
| Max. Negotiated Rate |
$2,609.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,197.60
|
| Rate for Payer: Cash Price |
$1,648.20
|
| Rate for Payer: Cash Price |
$1,648.20
|
| Rate for Payer: Cigna Commercial |
$2,334.95
|
| Rate for Payer: First Health Commercial |
$2,472.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,472.30
|
| Rate for Payer: GEHA Commercial |
$1,922.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,472.30
|
| Rate for Payer: Multiplan All |
$2,499.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,922.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,472.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,609.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,060.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,554.71
|
| Rate for Payer: Zelis Auto |
$1,098.80
|
|
