|
IMPLT PLATE BROAD STR 91MM 7-HOLE
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.40 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,420.80
|
| 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 |
$1,243.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,598.40
|
| Rate for Payer: Multiplan All |
$1,616.16
|
| 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: United Payors & United Providers UP&UP |
$1,651.68
|
| Rate for Payer: Zelis Auto |
$710.40
|
|
|
IMPLT PLATE CALCANEUS LOCKING 3.5MM
|
Facility
|
OP
|
$2,545.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$636.25 |
| Max. Negotiated Rate |
$2,417.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,527.00
|
| Rate for Payer: Cash Price |
$1,527.00
|
| Rate for Payer: Cash Price |
$1,527.00
|
| Rate for Payer: Cigna Commercial |
$2,163.25
|
| Rate for Payer: First Health Commercial |
$2,290.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,290.50
|
| Rate for Payer: GEHA Commercial |
$2,036.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,290.50
|
| Rate for Payer: Humana ChoiceCare |
$661.70
|
| Rate for Payer: Multiplan All |
$2,315.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,527.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,781.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,290.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,417.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,908.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,239.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$636.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,366.85
|
| Rate for Payer: Zelis Auto |
$1,018.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,272.50
|
|
|
IMPLT PLATE CALCANEUS LOCKING 3.5MM
|
Facility
|
IP
|
$2,545.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.00 |
| Max. Negotiated Rate |
$2,417.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,036.00
|
| Rate for Payer: Cash Price |
$1,527.00
|
| Rate for Payer: Cash Price |
$1,527.00
|
| Rate for Payer: Cigna Commercial |
$2,163.25
|
| Rate for Payer: First Health Commercial |
$2,290.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,290.50
|
| Rate for Payer: GEHA Commercial |
$1,781.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,290.50
|
| Rate for Payer: Multiplan All |
$2,315.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,781.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,290.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,417.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,908.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,366.85
|
| Rate for Payer: Zelis Auto |
$1,018.00
|
|
|
IMPLT PLATE CLAVICAL SUPERIOR DISTAL
|
Facility
|
IP
|
$2,744.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,097.60 |
| Max. Negotiated Rate |
$2,606.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,195.20
|
| Rate for Payer: Cash Price |
$1,646.40
|
| Rate for Payer: Cash Price |
$1,646.40
|
| Rate for Payer: Cigna Commercial |
$2,332.40
|
| Rate for Payer: First Health Commercial |
$2,469.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,469.60
|
| Rate for Payer: GEHA Commercial |
$1,920.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,469.60
|
| Rate for Payer: Multiplan All |
$2,497.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,920.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,469.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,606.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,058.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,551.92
|
| Rate for Payer: Zelis Auto |
$1,097.60
|
|
|
IMPLT PLATE CLAVICAL SUPERIOR DISTAL
|
Facility
|
OP
|
$2,744.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.00 |
| Max. Negotiated Rate |
$2,606.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,646.40
|
| Rate for Payer: Cash Price |
$1,646.40
|
| Rate for Payer: Cash Price |
$1,646.40
|
| Rate for Payer: Cigna Commercial |
$2,332.40
|
| Rate for Payer: First Health Commercial |
$2,469.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,469.60
|
| Rate for Payer: GEHA Commercial |
$2,195.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,469.60
|
| Rate for Payer: Humana ChoiceCare |
$713.44
|
| Rate for Payer: Multiplan All |
$2,497.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,646.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,920.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,469.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,606.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,058.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,414.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$686.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,551.92
|
| Rate for Payer: Zelis Auto |
$1,097.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,372.00
|
|
|
IMPLT PLATE CLAVICLE 6 HOLE 99MM LT
|
Facility
|
OP
|
$4,048.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.00 |
| Max. Negotiated Rate |
$3,845.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cigna Commercial |
$3,440.80
|
| Rate for Payer: First Health Commercial |
$3,643.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,643.20
|
| Rate for Payer: GEHA Commercial |
$3,238.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,643.20
|
| Rate for Payer: Humana ChoiceCare |
$1,052.48
|
| Rate for Payer: Multiplan All |
$3,683.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,428.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,833.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,643.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,845.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,036.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,562.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,012.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,764.64
|
| Rate for Payer: Zelis Auto |
$1,619.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,024.00
|
|
|
IMPLT PLATE CLAVICLE 6 HOLE 99MM LT
|
Facility
|
IP
|
$4,048.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,619.20 |
| Max. Negotiated Rate |
$3,845.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,238.40
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cigna Commercial |
$3,440.80
|
| Rate for Payer: First Health Commercial |
$3,643.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,643.20
|
| Rate for Payer: GEHA Commercial |
$2,833.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,643.20
|
| Rate for Payer: Multiplan All |
$3,683.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,833.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,643.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,845.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,036.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,764.64
|
| Rate for Payer: Zelis Auto |
$1,619.20
|
|
|
IMPLT PLATE CLAVICLE 8HLX99MM
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002967
|
|
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 CLAVICLE 8HLX99MM
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002967
|
|
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 CLAVICLE 8 HOLE 96MM
|
Facility
|
IP
|
$3,314.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,325.60 |
| Max. Negotiated Rate |
$3,148.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,651.20
|
| Rate for Payer: Cash Price |
$1,988.40
|
| Rate for Payer: Cash Price |
$1,988.40
|
| Rate for Payer: Cigna Commercial |
$2,816.90
|
| Rate for Payer: First Health Commercial |
$2,982.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,982.60
|
| Rate for Payer: GEHA Commercial |
$2,319.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,982.60
|
| Rate for Payer: Multiplan All |
$3,015.74
|
| Rate for Payer: OMNI Networks Commercial |
$2,319.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,982.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,148.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,485.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,082.02
|
| Rate for Payer: Zelis Auto |
$1,325.60
|
|
|
IMPLT PLATE CLAVICLE 8 HOLE 96MM
|
Facility
|
OP
|
$3,314.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$828.50 |
| Max. Negotiated Rate |
$3,148.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,988.40
|
| Rate for Payer: Cash Price |
$1,988.40
|
| Rate for Payer: Cash Price |
$1,988.40
|
| Rate for Payer: Cigna Commercial |
$2,816.90
|
| Rate for Payer: First Health Commercial |
$2,982.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,982.60
|
| Rate for Payer: GEHA Commercial |
$2,651.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,982.60
|
| Rate for Payer: Humana ChoiceCare |
$861.64
|
| Rate for Payer: Multiplan All |
$3,015.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,988.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,319.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,982.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,148.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,485.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,916.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$828.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,082.02
|
| Rate for Payer: Zelis Auto |
$1,325.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,657.00
|
|
|
IMPLT PLATE CLAVICLE HOLE 10
|
Facility
|
IP
|
$4,150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.00 |
| Max. Negotiated Rate |
$3,942.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,320.00
|
| Rate for Payer: Cash Price |
$2,490.00
|
| Rate for Payer: Cash Price |
$2,490.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$3,735.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,735.00
|
| Rate for Payer: GEHA Commercial |
$2,905.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,735.00
|
| Rate for Payer: Multiplan All |
$3,776.50
|
| Rate for Payer: OMNI Networks Commercial |
$2,905.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,735.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,942.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,112.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,859.50
|
| Rate for Payer: Zelis Auto |
$1,660.00
|
|
|
IMPLT PLATE CLAVICLE HOLE 10
|
Facility
|
OP
|
$4,150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.50 |
| Max. Negotiated Rate |
$3,942.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,490.00
|
| Rate for Payer: Cash Price |
$2,490.00
|
| Rate for Payer: Cash Price |
$2,490.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$3,735.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,735.00
|
| Rate for Payer: GEHA Commercial |
$3,320.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,735.00
|
| Rate for Payer: Humana ChoiceCare |
$1,079.00
|
| Rate for Payer: Multiplan All |
$3,776.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,490.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,905.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,735.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,942.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,112.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,652.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,037.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,859.50
|
| Rate for Payer: Zelis Auto |
$1,660.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,075.00
|
|
|
IMPLT PLATE CLAVICLE HOLE SEVEN
|
Facility
|
OP
|
$3,452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.00 |
| Max. Negotiated Rate |
$3,279.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,071.20
|
| Rate for Payer: Cash Price |
$2,071.20
|
| Rate for Payer: Cash Price |
$2,071.20
|
| Rate for Payer: Cigna Commercial |
$2,934.20
|
| Rate for Payer: First Health Commercial |
$3,106.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,106.80
|
| Rate for Payer: GEHA Commercial |
$2,761.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,106.80
|
| Rate for Payer: Humana ChoiceCare |
$897.52
|
| Rate for Payer: Multiplan All |
$3,141.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,071.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,416.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,106.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,279.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,589.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,037.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$863.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,210.36
|
| Rate for Payer: Zelis Auto |
$1,380.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,726.00
|
|
|
IMPLT PLATE CLAVICLE HOLE SEVEN
|
Facility
|
IP
|
$3,452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.80 |
| Max. Negotiated Rate |
$3,279.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,761.60
|
| Rate for Payer: Cash Price |
$2,071.20
|
| Rate for Payer: Cash Price |
$2,071.20
|
| Rate for Payer: Cigna Commercial |
$2,934.20
|
| Rate for Payer: First Health Commercial |
$3,106.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,106.80
|
| Rate for Payer: GEHA Commercial |
$2,416.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,106.80
|
| Rate for Payer: Multiplan All |
$3,141.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,416.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,106.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,279.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,589.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,210.36
|
| Rate for Payer: Zelis Auto |
$1,380.80
|
|
|
IMPLT PLATE CLAVICLE HOLE SIX
|
Facility
|
OP
|
$3,452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.00 |
| Max. Negotiated Rate |
$3,279.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,071.20
|
| Rate for Payer: Cash Price |
$2,071.20
|
| Rate for Payer: Cash Price |
$2,071.20
|
| Rate for Payer: Cigna Commercial |
$2,934.20
|
| Rate for Payer: First Health Commercial |
$3,106.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,106.80
|
| Rate for Payer: GEHA Commercial |
$2,761.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,106.80
|
| Rate for Payer: Humana ChoiceCare |
$897.52
|
| Rate for Payer: Multiplan All |
$3,141.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,071.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,416.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,106.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,279.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,589.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,037.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$863.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,210.36
|
| Rate for Payer: Zelis Auto |
$1,380.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,726.00
|
|
|
IMPLT PLATE CLAVICLE HOLE SIX
|
Facility
|
IP
|
$3,452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.80 |
| Max. Negotiated Rate |
$3,279.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,761.60
|
| Rate for Payer: Cash Price |
$2,071.20
|
| Rate for Payer: Cash Price |
$2,071.20
|
| Rate for Payer: Cigna Commercial |
$2,934.20
|
| Rate for Payer: First Health Commercial |
$3,106.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,106.80
|
| Rate for Payer: GEHA Commercial |
$2,416.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,106.80
|
| Rate for Payer: Multiplan All |
$3,141.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,416.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,106.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,279.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,589.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,210.36
|
| Rate for Payer: Zelis Auto |
$1,380.80
|
|
|
IMPLT PLATE CLAVICLE VARIAX 3HL RT LAT
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003373
|
|
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 CLAVICLE VARIAX 3HL RT LAT
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003373
|
|
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 CLAVICLE VARIAX 4HL RT LAT
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006638
|
|
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 CLAVICLE VARIAX 4HL RT LAT
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006638
|
|
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 COLUMN ULNAR L SHORT
|
Facility
|
OP
|
$2,530.00
|
|
| Hospital Charge Code |
7006609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.50 |
| Max. Negotiated Rate |
$2,403.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,518.00
|
| Rate for Payer: Cash Price |
$1,518.00
|
| Rate for Payer: Cash Price |
$1,518.00
|
| Rate for Payer: Cigna Commercial |
$2,150.50
|
| Rate for Payer: First Health Commercial |
$2,277.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,277.00
|
| Rate for Payer: GEHA Commercial |
$2,024.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,277.00
|
| Rate for Payer: Humana ChoiceCare |
$657.80
|
| Rate for Payer: Multiplan All |
$2,302.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,518.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,771.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,277.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,403.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,897.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,226.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$632.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,352.90
|
| Rate for Payer: Zelis Auto |
$1,012.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,265.00
|
|
|
IMPLT PLATE COLUMN ULNAR L SHORT
|
Facility
|
IP
|
$2,530.00
|
|
| Hospital Charge Code |
7006609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.00 |
| Max. Negotiated Rate |
$2,403.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,024.00
|
| Rate for Payer: Cash Price |
$1,518.00
|
| Rate for Payer: Cash Price |
$1,518.00
|
| Rate for Payer: Cigna Commercial |
$2,150.50
|
| Rate for Payer: First Health Commercial |
$2,277.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,277.00
|
| Rate for Payer: GEHA Commercial |
$1,771.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,277.00
|
| Rate for Payer: Multiplan All |
$2,302.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,771.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,277.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,403.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,897.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,352.90
|
| Rate for Payer: Zelis Auto |
$1,012.00
|
|
|
IMPLT PLATE COMPRESSION 3.5MM
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$696.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Humana ChoiceCare |
$226.46
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$522.60
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$766.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$217.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$435.50
|
|
|
IMPLT PLATE COMPRESSION 3.5MM
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.80
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$609.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
|
