|
IMPLT PLATE COMPRESSION 3.5MM HOLE 5
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$867.00
|
| Rate for Payer: First Health Commercial |
$918.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$918.00
|
| Rate for Payer: GEHA Commercial |
$816.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$918.00
|
| Rate for Payer: Humana ChoiceCare |
$265.20
|
| Rate for Payer: Multiplan All |
$928.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$612.00
|
| Rate for Payer: OMNI Networks Commercial |
$714.00
|
| Rate for Payer: One Health Plan PPO/POS |
$918.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$969.00
|
| Rate for Payer: Three Rivers Provider Network All |
$765.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$897.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$255.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$948.60
|
| Rate for Payer: Zelis Auto |
$408.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$510.00
|
|
|
IMPLT PLATE COMPRESSION 3.5MM HOLE 5
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$816.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$867.00
|
| Rate for Payer: First Health Commercial |
$918.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$918.00
|
| Rate for Payer: GEHA Commercial |
$714.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$918.00
|
| Rate for Payer: Multiplan All |
$928.20
|
| Rate for Payer: OMNI Networks Commercial |
$714.00
|
| Rate for Payer: One Health Plan PPO/POS |
$918.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$969.00
|
| Rate for Payer: Three Rivers Provider Network All |
$765.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$948.60
|
| Rate for Payer: Zelis Auto |
$408.00
|
|
|
IMPLT PLATE COMPRESSION 4.5X195MM
|
Facility
|
OP
|
$1,213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.25 |
| Max. Negotiated Rate |
$1,152.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$727.80
|
| Rate for Payer: Cash Price |
$727.80
|
| Rate for Payer: Cash Price |
$727.80
|
| Rate for Payer: Cigna Commercial |
$1,031.05
|
| Rate for Payer: First Health Commercial |
$1,091.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,091.70
|
| Rate for Payer: GEHA Commercial |
$970.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,091.70
|
| Rate for Payer: Humana ChoiceCare |
$315.38
|
| Rate for Payer: Multiplan All |
$1,103.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$727.80
|
| Rate for Payer: OMNI Networks Commercial |
$849.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,091.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,152.35
|
| Rate for Payer: Three Rivers Provider Network All |
$909.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,067.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$303.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,128.09
|
| Rate for Payer: Zelis Auto |
$485.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$606.50
|
|
|
IMPLT PLATE COMPRESSION 4.5X195MM
|
Facility
|
IP
|
$1,213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.20 |
| Max. Negotiated Rate |
$1,152.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$970.40
|
| Rate for Payer: Cash Price |
$727.80
|
| Rate for Payer: Cash Price |
$727.80
|
| Rate for Payer: Cigna Commercial |
$1,031.05
|
| Rate for Payer: First Health Commercial |
$1,091.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,091.70
|
| Rate for Payer: GEHA Commercial |
$849.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,091.70
|
| Rate for Payer: Multiplan All |
$1,103.83
|
| Rate for Payer: OMNI Networks Commercial |
$849.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,091.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,152.35
|
| Rate for Payer: Three Rivers Provider Network All |
$909.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,128.09
|
| Rate for Payer: Zelis Auto |
$485.20
|
|
|
IMPLT PLATE COMPRESSION 7 HOLE
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001178
|
|
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 7 HOLE
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001178
|
|
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
|
|
|
IMPLT PLATE COMPRESSION 8 HOLE 2.3MM
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.20 |
| Max. Negotiated Rate |
$1,456.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,226.40
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,303.05
|
| Rate for Payer: First Health Commercial |
$1,379.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,379.70
|
| Rate for Payer: GEHA Commercial |
$1,073.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,379.70
|
| Rate for Payer: Multiplan All |
$1,395.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,073.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,379.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,456.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,149.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,425.69
|
| Rate for Payer: Zelis Auto |
$613.20
|
|
|
IMPLT PLATE COMPRESSION 8 HOLE 2.3MM
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.25 |
| Max. Negotiated Rate |
$1,456.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$919.80
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,303.05
|
| Rate for Payer: First Health Commercial |
$1,379.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,379.70
|
| Rate for Payer: GEHA Commercial |
$1,226.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,379.70
|
| Rate for Payer: Humana ChoiceCare |
$398.58
|
| Rate for Payer: Multiplan All |
$1,395.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$919.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,073.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,379.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,456.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,149.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,349.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$383.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,425.69
|
| Rate for Payer: Zelis Auto |
$613.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$766.50
|
|
|
IMPLT PLATE COMPRESSION HOLE 10
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002589
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$196.75 |
| Max. Negotiated Rate |
$747.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$472.20
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Cigna Commercial |
$668.95
|
| Rate for Payer: First Health Commercial |
$708.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$708.30
|
| Rate for Payer: GEHA Commercial |
$629.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$708.30
|
| Rate for Payer: Humana ChoiceCare |
$204.62
|
| Rate for Payer: Multiplan All |
$716.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$472.20
|
| Rate for Payer: OMNI Networks Commercial |
$550.90
|
| Rate for Payer: One Health Plan PPO/POS |
$708.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$747.65
|
| Rate for Payer: Three Rivers Provider Network All |
$590.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$692.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$731.91
|
| Rate for Payer: Zelis Auto |
$314.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$393.50
|
|
|
IMPLT PLATE COMPRESSION HOLE 10
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002589
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$314.80 |
| Max. Negotiated Rate |
$747.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$629.60
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Cigna Commercial |
$668.95
|
| Rate for Payer: First Health Commercial |
$708.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$708.30
|
| Rate for Payer: GEHA Commercial |
$550.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$708.30
|
| Rate for Payer: Multiplan All |
$716.17
|
| Rate for Payer: OMNI Networks Commercial |
$550.90
|
| Rate for Payer: One Health Plan PPO/POS |
$708.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$747.65
|
| Rate for Payer: Three Rivers Provider Network All |
$590.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$731.91
|
| Rate for Payer: Zelis Auto |
$314.80
|
|
|
IMPLT PLATE COMPRESSION HOLE 4
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT PLATE COMPRESSION HOLE 4
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT PLATE COMPRESSION HOLE 8
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002999
|
|
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 COMPRESSION HOLE 8
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002999
|
|
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 COMPRESSION HOLE 9
|
Facility
|
IP
|
$2,207.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.80 |
| Max. Negotiated Rate |
$2,096.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,765.60
|
| Rate for Payer: Cash Price |
$1,324.20
|
| Rate for Payer: Cash Price |
$1,324.20
|
| Rate for Payer: Cigna Commercial |
$1,875.95
|
| Rate for Payer: First Health Commercial |
$1,986.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,986.30
|
| Rate for Payer: GEHA Commercial |
$1,544.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,986.30
|
| Rate for Payer: Multiplan All |
$2,008.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,544.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,986.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,096.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,655.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,052.51
|
| Rate for Payer: Zelis Auto |
$882.80
|
|
|
IMPLT PLATE COMPRESSION HOLE 9
|
Facility
|
OP
|
$2,207.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.75 |
| Max. Negotiated Rate |
$2,096.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,324.20
|
| Rate for Payer: Cash Price |
$1,324.20
|
| Rate for Payer: Cash Price |
$1,324.20
|
| Rate for Payer: Cigna Commercial |
$1,875.95
|
| Rate for Payer: First Health Commercial |
$1,986.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,986.30
|
| Rate for Payer: GEHA Commercial |
$1,765.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,986.30
|
| Rate for Payer: Humana ChoiceCare |
$573.82
|
| Rate for Payer: Multiplan All |
$2,008.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,324.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,544.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,986.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,096.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,655.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,942.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$551.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,052.51
|
| Rate for Payer: Zelis Auto |
$882.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,103.50
|
|
|
IMPLT PLATE COMPRESSION NARROW
|
Facility
|
OP
|
$1,776.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009037
|
|
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
|
|
|
IMPLT PLATE COMPRESSION NARROW
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009037
|
|
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 DCP 114MM
|
Facility
|
IP
|
$2,297.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.80 |
| Max. Negotiated Rate |
$2,182.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,837.60
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$1,952.45
|
| Rate for Payer: First Health Commercial |
$2,067.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,067.30
|
| Rate for Payer: GEHA Commercial |
$1,607.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,067.30
|
| Rate for Payer: Multiplan All |
$2,090.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,607.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,067.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,182.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,722.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,136.21
|
| Rate for Payer: Zelis Auto |
$918.80
|
|
|
IMPLT PLATE DCP 114MM
|
Facility
|
OP
|
$2,297.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.25 |
| Max. Negotiated Rate |
$2,182.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,378.20
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$1,952.45
|
| Rate for Payer: First Health Commercial |
$2,067.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,067.30
|
| Rate for Payer: GEHA Commercial |
$1,837.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,067.30
|
| Rate for Payer: Humana ChoiceCare |
$597.22
|
| Rate for Payer: Multiplan All |
$2,090.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,378.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,607.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,067.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,182.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,722.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,021.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$574.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,136.21
|
| Rate for Payer: Zelis Auto |
$918.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,148.50
|
|
|
IMPLT PLATE DCP 3.5MM
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.75 |
| Max. Negotiated Rate |
$1,108.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cigna Commercial |
$991.95
|
| Rate for Payer: First Health Commercial |
$1,050.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,050.30
|
| Rate for Payer: GEHA Commercial |
$933.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,050.30
|
| Rate for Payer: Humana ChoiceCare |
$303.42
|
| Rate for Payer: Multiplan All |
$1,061.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$700.20
|
| Rate for Payer: OMNI Networks Commercial |
$816.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,050.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,108.65
|
| Rate for Payer: Three Rivers Provider Network All |
$875.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,026.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$291.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,085.31
|
| Rate for Payer: Zelis Auto |
$466.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$583.50
|
|
|
IMPLT PLATE DCP 3.5MM
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.80 |
| Max. Negotiated Rate |
$1,108.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$933.60
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cigna Commercial |
$991.95
|
| Rate for Payer: First Health Commercial |
$1,050.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,050.30
|
| Rate for Payer: GEHA Commercial |
$816.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,050.30
|
| Rate for Payer: Multiplan All |
$1,061.97
|
| Rate for Payer: OMNI Networks Commercial |
$816.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,050.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,108.65
|
| Rate for Payer: Three Rivers Provider Network All |
$875.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,085.31
|
| Rate for Payer: Zelis Auto |
$466.80
|
|
|
IMPLT PLATE DCP 3.5X73MM HOLE 6
|
Facility
|
OP
|
$989.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.25 |
| Max. Negotiated Rate |
$939.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$593.40
|
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Cigna Commercial |
$840.65
|
| Rate for Payer: First Health Commercial |
$890.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$890.10
|
| Rate for Payer: GEHA Commercial |
$791.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$890.10
|
| Rate for Payer: Humana ChoiceCare |
$257.14
|
| Rate for Payer: Multiplan All |
$899.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$593.40
|
| Rate for Payer: OMNI Networks Commercial |
$692.30
|
| Rate for Payer: One Health Plan PPO/POS |
$890.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$939.55
|
| Rate for Payer: Three Rivers Provider Network All |
$741.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$870.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$247.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$919.77
|
| Rate for Payer: Zelis Auto |
$395.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$494.50
|
|
|
IMPLT PLATE DCP 3.5X73MM HOLE 6
|
Facility
|
IP
|
$989.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$395.60 |
| Max. Negotiated Rate |
$939.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$791.20
|
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Cigna Commercial |
$840.65
|
| Rate for Payer: First Health Commercial |
$890.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$890.10
|
| Rate for Payer: GEHA Commercial |
$692.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$890.10
|
| Rate for Payer: Multiplan All |
$899.99
|
| Rate for Payer: OMNI Networks Commercial |
$692.30
|
| Rate for Payer: One Health Plan PPO/POS |
$890.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$939.55
|
| Rate for Payer: Three Rivers Provider Network All |
$741.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$919.77
|
| Rate for Payer: Zelis Auto |
$395.60
|
|
|
IMPLT PLATE DCP 3.5X85MM 7HOLE
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$408.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$433.50
|
| Rate for Payer: First Health Commercial |
$459.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$459.00
|
| Rate for Payer: GEHA Commercial |
$357.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.00
|
| Rate for Payer: Multiplan All |
$464.10
|
| Rate for Payer: OMNI Networks Commercial |
$357.00
|
| Rate for Payer: One Health Plan PPO/POS |
$459.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$484.50
|
| Rate for Payer: Three Rivers Provider Network All |
$382.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$474.30
|
| Rate for Payer: Zelis Auto |
$204.00
|
|
