|
IMPLT PLATE 9 HOLE STANDARD LOCKING
|
Facility
|
IP
|
$2,284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001173
|
|
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 9 HOLE STANDARD LOCKING
|
Facility
|
OP
|
$2,284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001173
|
|
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 9H RIGHT 131MM
|
Facility
|
OP
|
$2,747.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001174
|
|
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 9H RIGHT 131MM
|
Facility
|
IP
|
$2,747.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001174
|
|
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
|
|
|
IMPLT PLATE ANGLE 2.4X47X97MM TI LEFT
|
Facility
|
IP
|
$4,779.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,911.60 |
| Max. Negotiated Rate |
$4,540.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,823.20
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Cigna Commercial |
$4,062.15
|
| Rate for Payer: First Health Commercial |
$4,301.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,301.10
|
| Rate for Payer: GEHA Commercial |
$3,345.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,301.10
|
| Rate for Payer: Multiplan All |
$4,348.89
|
| Rate for Payer: OMNI Networks Commercial |
$3,345.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,301.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,540.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,584.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,444.47
|
| Rate for Payer: Zelis Auto |
$1,911.60
|
|
|
IMPLT PLATE ANGLE 2.4X47X97MM TI LEFT
|
Facility
|
OP
|
$4,779.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.75 |
| Max. Negotiated Rate |
$4,540.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,867.40
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Cigna Commercial |
$4,062.15
|
| Rate for Payer: First Health Commercial |
$4,301.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,301.10
|
| Rate for Payer: GEHA Commercial |
$3,823.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,301.10
|
| Rate for Payer: Humana ChoiceCare |
$1,242.54
|
| Rate for Payer: Multiplan All |
$4,348.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,867.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,345.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,301.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,540.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,584.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,205.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,194.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,444.47
|
| Rate for Payer: Zelis Auto |
$1,911.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,389.50
|
|
|
IMPLT PLATE ANGLE 2.4X47X97MM TI RIGHT
|
Facility
|
IP
|
$4,779.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,911.60 |
| Max. Negotiated Rate |
$4,540.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,823.20
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Cigna Commercial |
$4,062.15
|
| Rate for Payer: First Health Commercial |
$4,301.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,301.10
|
| Rate for Payer: GEHA Commercial |
$3,345.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,301.10
|
| Rate for Payer: Multiplan All |
$4,348.89
|
| Rate for Payer: OMNI Networks Commercial |
$3,345.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,301.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,540.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,584.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,444.47
|
| Rate for Payer: Zelis Auto |
$1,911.60
|
|
|
IMPLT PLATE ANGLE 2.4X47X97MM TI RIGHT
|
Facility
|
OP
|
$4,779.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.75 |
| Max. Negotiated Rate |
$4,540.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,867.40
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Cash Price |
$2,867.40
|
| Rate for Payer: Cigna Commercial |
$4,062.15
|
| Rate for Payer: First Health Commercial |
$4,301.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,301.10
|
| Rate for Payer: GEHA Commercial |
$3,823.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,301.10
|
| Rate for Payer: Humana ChoiceCare |
$1,242.54
|
| Rate for Payer: Multiplan All |
$4,348.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,867.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,345.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,301.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,540.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,584.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,205.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,194.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,444.47
|
| Rate for Payer: Zelis Auto |
$1,911.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,389.50
|
|
|
IMPLT PLATE ANKLE 3.5MM
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.75 |
| Max. Negotiated Rate |
$1,925.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,216.20
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cigna Commercial |
$1,722.95
|
| Rate for Payer: First Health Commercial |
$1,824.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,824.30
|
| Rate for Payer: GEHA Commercial |
$1,621.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,824.30
|
| Rate for Payer: Humana ChoiceCare |
$527.02
|
| Rate for Payer: Multiplan All |
$1,844.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,216.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,418.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,824.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,925.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,520.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,783.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$506.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,885.11
|
| Rate for Payer: Zelis Auto |
$810.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,013.50
|
|
|
IMPLT PLATE ANKLE 3.5MM
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$810.80 |
| Max. Negotiated Rate |
$1,925.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,621.60
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cigna Commercial |
$1,722.95
|
| Rate for Payer: First Health Commercial |
$1,824.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,824.30
|
| Rate for Payer: GEHA Commercial |
$1,418.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,824.30
|
| Rate for Payer: Multiplan All |
$1,844.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,418.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,824.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,925.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,520.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,885.11
|
| Rate for Payer: Zelis Auto |
$810.80
|
|
|
IMPLT PLATE ANTERIOR RIGHT HOLE 10
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.80 |
| Max. Negotiated Rate |
$3,564.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,001.60
|
| 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 |
$2,626.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,376.80
|
| Rate for Payer: Multiplan All |
$3,414.32
|
| 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: United Payors & United Providers UP&UP |
$3,489.36
|
| Rate for Payer: Zelis Auto |
$1,500.80
|
|
|
IMPLT PLATE ANTERIOR RIGHT HOLE 10
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000314
|
|
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 BEND SHORT
|
Facility
|
IP
|
$8,582.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,432.80 |
| Max. Negotiated Rate |
$8,152.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,865.60
|
| Rate for Payer: Cash Price |
$5,149.20
|
| Rate for Payer: Cash Price |
$5,149.20
|
| Rate for Payer: Cigna Commercial |
$7,294.70
|
| Rate for Payer: First Health Commercial |
$7,723.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,723.80
|
| Rate for Payer: GEHA Commercial |
$6,007.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,723.80
|
| Rate for Payer: Multiplan All |
$7,809.62
|
| Rate for Payer: OMNI Networks Commercial |
$6,007.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,723.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,152.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,436.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,981.26
|
| Rate for Payer: Zelis Auto |
$3,432.80
|
|
|
IMPLT PLATE BEND SHORT
|
Facility
|
OP
|
$8,582.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,145.50 |
| Max. Negotiated Rate |
$8,152.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,149.20
|
| Rate for Payer: Cash Price |
$5,149.20
|
| Rate for Payer: Cash Price |
$5,149.20
|
| Rate for Payer: Cigna Commercial |
$7,294.70
|
| Rate for Payer: First Health Commercial |
$7,723.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,723.80
|
| Rate for Payer: GEHA Commercial |
$6,865.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,723.80
|
| Rate for Payer: Humana ChoiceCare |
$2,231.32
|
| Rate for Payer: Multiplan All |
$7,809.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,149.20
|
| Rate for Payer: OMNI Networks Commercial |
$6,007.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,723.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,152.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,436.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,552.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,145.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,981.26
|
| Rate for Payer: Zelis Auto |
$3,432.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,291.00
|
|
|
IMPLT PLATE BOW 4MM SPACER
|
Facility
|
OP
|
$5,545.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,386.25 |
| Max. Negotiated Rate |
$5,267.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,327.00
|
| Rate for Payer: Cash Price |
$3,327.00
|
| Rate for Payer: Cash Price |
$3,327.00
|
| Rate for Payer: Cigna Commercial |
$4,713.25
|
| Rate for Payer: First Health Commercial |
$4,990.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,990.50
|
| Rate for Payer: GEHA Commercial |
$4,436.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,990.50
|
| Rate for Payer: Humana ChoiceCare |
$1,441.70
|
| Rate for Payer: Multiplan All |
$5,045.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,327.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,881.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,990.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,267.75
|
| Rate for Payer: Three Rivers Provider Network All |
$4,158.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,879.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,156.85
|
| Rate for Payer: Zelis Auto |
$2,218.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,772.50
|
|
|
IMPLT PLATE BOW 4MM SPACER
|
Facility
|
IP
|
$5,545.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,218.00 |
| Max. Negotiated Rate |
$5,267.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,436.00
|
| Rate for Payer: Cash Price |
$3,327.00
|
| Rate for Payer: Cash Price |
$3,327.00
|
| Rate for Payer: Cigna Commercial |
$4,713.25
|
| Rate for Payer: First Health Commercial |
$4,990.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,990.50
|
| Rate for Payer: GEHA Commercial |
$3,881.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,990.50
|
| Rate for Payer: Multiplan All |
$5,045.95
|
| Rate for Payer: OMNI Networks Commercial |
$3,881.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,990.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,267.75
|
| Rate for Payer: Three Rivers Provider Network All |
$4,158.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,156.85
|
| Rate for Payer: Zelis Auto |
$2,218.00
|
|
|
IMPLT PLATE BRD CRV 151MM 12 HL CMPR VAR
|
Facility
|
IP
|
$2,753.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.20 |
| Max. Negotiated Rate |
$2,615.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,202.40
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cigna Commercial |
$2,340.05
|
| Rate for Payer: First Health Commercial |
$2,477.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,477.70
|
| Rate for Payer: GEHA Commercial |
$1,927.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,477.70
|
| Rate for Payer: Multiplan All |
$2,505.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,927.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,477.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,615.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,064.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,560.29
|
| Rate for Payer: Zelis Auto |
$1,101.20
|
|
|
IMPLT PLATE BRD CRV 151MM 12 HL CMPR VAR
|
Facility
|
OP
|
$2,753.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$688.25 |
| Max. Negotiated Rate |
$2,615.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,651.80
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cigna Commercial |
$2,340.05
|
| Rate for Payer: First Health Commercial |
$2,477.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,477.70
|
| Rate for Payer: GEHA Commercial |
$2,202.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,477.70
|
| Rate for Payer: Humana ChoiceCare |
$715.78
|
| Rate for Payer: Multiplan All |
$2,505.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,651.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,927.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,477.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,615.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,064.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,422.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$688.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,560.29
|
| Rate for Payer: Zelis Auto |
$1,101.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,376.50
|
|
|
IMPLT PLATE BROAD CURVED 10-HOLE
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.40 |
| Max. Negotiated Rate |
$2,314.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,948.80
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cigna Commercial |
$2,070.60
|
| Rate for Payer: First Health Commercial |
$2,192.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,192.40
|
| Rate for Payer: GEHA Commercial |
$1,705.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,192.40
|
| Rate for Payer: Multiplan All |
$2,216.76
|
| Rate for Payer: OMNI Networks Commercial |
$1,705.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,192.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,314.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,827.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,265.48
|
| Rate for Payer: Zelis Auto |
$974.40
|
|
|
IMPLT PLATE BROAD CURVED 10-HOLE
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.00 |
| Max. Negotiated Rate |
$2,314.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cigna Commercial |
$2,070.60
|
| Rate for Payer: First Health Commercial |
$2,192.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,192.40
|
| Rate for Payer: GEHA Commercial |
$1,948.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,192.40
|
| Rate for Payer: Humana ChoiceCare |
$633.36
|
| Rate for Payer: Multiplan All |
$2,216.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,461.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,705.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,192.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,314.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,827.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,143.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$609.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,265.48
|
| Rate for Payer: Zelis Auto |
$974.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,218.00
|
|
|
IMPLT PLATE BROAD CURVED 139MM 11-HOLE
|
Facility
|
IP
|
$2,753.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.20 |
| Max. Negotiated Rate |
$2,615.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,202.40
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cigna Commercial |
$2,340.05
|
| Rate for Payer: First Health Commercial |
$2,477.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,477.70
|
| Rate for Payer: GEHA Commercial |
$1,927.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,477.70
|
| Rate for Payer: Multiplan All |
$2,505.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,927.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,477.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,615.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,064.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,560.29
|
| Rate for Payer: Zelis Auto |
$1,101.20
|
|
|
IMPLT PLATE BROAD CURVED 139MM 11-HOLE
|
Facility
|
OP
|
$2,753.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$688.25 |
| Max. Negotiated Rate |
$2,615.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,651.80
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cigna Commercial |
$2,340.05
|
| Rate for Payer: First Health Commercial |
$2,477.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,477.70
|
| Rate for Payer: GEHA Commercial |
$2,202.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,477.70
|
| Rate for Payer: Humana ChoiceCare |
$715.78
|
| Rate for Payer: Multiplan All |
$2,505.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,651.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,927.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,477.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,615.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,064.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,422.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$688.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,560.29
|
| Rate for Payer: Zelis Auto |
$1,101.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,376.50
|
|
|
IMPLT PLATE BROAD L SHORT
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,639.20
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,309.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
|
|
IMPLT PLATE BROAD L SHORT
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.75 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Humana ChoiceCare |
$857.74
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,979.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,903.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,649.50
|
|
|
IMPLT PLATE BROAD STR 91MM 7-HOLE
|
Facility
|
OP
|
$1,776.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.00 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$1,509.60
|
| Rate for Payer: First Health Commercial |
$1,598.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,598.40
|
| Rate for Payer: GEHA Commercial |
$1,420.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,598.40
|
| Rate for Payer: Humana ChoiceCare |
$461.76
|
| Rate for Payer: Multiplan All |
$1,616.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,065.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,243.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,598.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,687.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,332.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,562.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$444.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,651.68
|
| Rate for Payer: Zelis Auto |
$710.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$888.00
|
|
