|
IMPLT PLATE DCP 3.5X85MM 7HOLE
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$306.00
|
| 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 |
$408.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$459.00
|
| Rate for Payer: Humana ChoiceCare |
$132.60
|
| Rate for Payer: Multiplan All |
$464.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$306.00
|
| 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: TriWest Veterans Administration/VAPC3 |
$448.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$474.30
|
| Rate for Payer: Zelis Auto |
$204.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$255.00
|
|
|
IMPLT PLATE DISTAL MEDIAL TIBIA
|
Facility
|
IP
|
$5,728.14
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.26 |
| Max. Negotiated Rate |
$5,441.73 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,582.51
|
| Rate for Payer: Cash Price |
$3,436.88
|
| Rate for Payer: Cash Price |
$3,436.88
|
| Rate for Payer: Cigna Commercial |
$4,868.92
|
| Rate for Payer: First Health Commercial |
$5,155.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,155.33
|
| Rate for Payer: GEHA Commercial |
$4,009.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,155.33
|
| Rate for Payer: Multiplan All |
$5,212.61
|
| Rate for Payer: OMNI Networks Commercial |
$4,009.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,155.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,441.73
|
| Rate for Payer: Three Rivers Provider Network All |
$4,296.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,327.17
|
| Rate for Payer: Zelis Auto |
$2,291.26
|
|
|
IMPLT PLATE DISTAL MEDIAL TIBIA
|
Facility
|
OP
|
$5,728.14
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.04 |
| Max. Negotiated Rate |
$5,441.73 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,436.88
|
| Rate for Payer: Cash Price |
$3,436.88
|
| Rate for Payer: Cash Price |
$3,436.88
|
| Rate for Payer: Cigna Commercial |
$4,868.92
|
| Rate for Payer: First Health Commercial |
$5,155.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,155.33
|
| Rate for Payer: GEHA Commercial |
$4,582.51
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,155.33
|
| Rate for Payer: Humana ChoiceCare |
$1,489.32
|
| Rate for Payer: Multiplan All |
$5,212.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,436.88
|
| Rate for Payer: OMNI Networks Commercial |
$4,009.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,155.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,441.73
|
| Rate for Payer: Three Rivers Provider Network All |
$4,296.10
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,040.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,432.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,327.17
|
| Rate for Payer: Zelis Auto |
$2,291.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,864.07
|
|
|
IMPLT PLATE DORSAL RIGHT LONG
|
Facility
|
IP
|
$3,959.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,583.60 |
| Max. Negotiated Rate |
$3,761.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,167.20
|
| Rate for Payer: Cash Price |
$2,375.40
|
| Rate for Payer: Cash Price |
$2,375.40
|
| Rate for Payer: Cigna Commercial |
$3,365.15
|
| Rate for Payer: First Health Commercial |
$3,563.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,563.10
|
| Rate for Payer: GEHA Commercial |
$2,771.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,563.10
|
| Rate for Payer: Multiplan All |
$3,602.69
|
| Rate for Payer: OMNI Networks Commercial |
$2,771.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,563.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,761.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,969.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,681.87
|
| Rate for Payer: Zelis Auto |
$1,583.60
|
|
|
IMPLT PLATE DORSAL RIGHT LONG
|
Facility
|
OP
|
$3,959.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.75 |
| Max. Negotiated Rate |
$3,761.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,375.40
|
| Rate for Payer: Cash Price |
$2,375.40
|
| Rate for Payer: Cash Price |
$2,375.40
|
| Rate for Payer: Cigna Commercial |
$3,365.15
|
| Rate for Payer: First Health Commercial |
$3,563.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,563.10
|
| Rate for Payer: GEHA Commercial |
$3,167.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,563.10
|
| Rate for Payer: Humana ChoiceCare |
$1,029.34
|
| Rate for Payer: Multiplan All |
$3,602.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,375.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,771.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,563.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,761.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,969.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,483.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$989.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,681.87
|
| Rate for Payer: Zelis Auto |
$1,583.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,979.50
|
|
|
IMPLT PLATE DORSAL SHORT LT
|
Facility
|
IP
|
$3,182.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.80 |
| Max. Negotiated Rate |
$3,022.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,545.60
|
| Rate for Payer: Cash Price |
$1,909.20
|
| Rate for Payer: Cash Price |
$1,909.20
|
| Rate for Payer: Cigna Commercial |
$2,704.70
|
| Rate for Payer: First Health Commercial |
$2,863.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,863.80
|
| Rate for Payer: GEHA Commercial |
$2,227.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,863.80
|
| Rate for Payer: Multiplan All |
$2,895.62
|
| Rate for Payer: OMNI Networks Commercial |
$2,227.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,863.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,022.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,386.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,959.26
|
| Rate for Payer: Zelis Auto |
$1,272.80
|
|
|
IMPLT PLATE DORSAL SHORT LT
|
Facility
|
OP
|
$3,182.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$795.50 |
| Max. Negotiated Rate |
$3,022.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,909.20
|
| Rate for Payer: Cash Price |
$1,909.20
|
| Rate for Payer: Cash Price |
$1,909.20
|
| Rate for Payer: Cigna Commercial |
$2,704.70
|
| Rate for Payer: First Health Commercial |
$2,863.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,863.80
|
| Rate for Payer: GEHA Commercial |
$2,545.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,863.80
|
| Rate for Payer: Humana ChoiceCare |
$827.32
|
| Rate for Payer: Multiplan All |
$2,895.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,909.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,227.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,863.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,022.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,386.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,800.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$795.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,959.26
|
| Rate for Payer: Zelis Auto |
$1,272.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,591.00
|
|
|
IMPLT PLATE DOUBLE SPIKED
|
Facility
|
IP
|
$939.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.60 |
| Max. Negotiated Rate |
$892.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$751.20
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$798.15
|
| Rate for Payer: First Health Commercial |
$845.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$845.10
|
| Rate for Payer: GEHA Commercial |
$657.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$845.10
|
| Rate for Payer: Multiplan All |
$854.49
|
| Rate for Payer: OMNI Networks Commercial |
$657.30
|
| Rate for Payer: One Health Plan PPO/POS |
$845.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$892.05
|
| Rate for Payer: Three Rivers Provider Network All |
$704.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$873.27
|
| Rate for Payer: Zelis Auto |
$375.60
|
|
|
IMPLT PLATE DOUBLE SPIKED
|
Facility
|
OP
|
$939.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.75 |
| Max. Negotiated Rate |
$892.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$563.40
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$798.15
|
| Rate for Payer: First Health Commercial |
$845.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$845.10
|
| Rate for Payer: GEHA Commercial |
$751.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$845.10
|
| Rate for Payer: Humana ChoiceCare |
$244.14
|
| Rate for Payer: Multiplan All |
$854.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$563.40
|
| Rate for Payer: OMNI Networks Commercial |
$657.30
|
| Rate for Payer: One Health Plan PPO/POS |
$845.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$892.05
|
| Rate for Payer: Three Rivers Provider Network All |
$704.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$826.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$234.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$873.27
|
| Rate for Payer: Zelis Auto |
$375.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$469.50
|
|
|
IMPLT PLATE DR STANDARD R
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003055
|
|
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 DR STANDARD R
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003055
|
|
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 DR VOLAR 11 HL NAR 2.7 LT
|
Facility
|
OP
|
$5,358.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,339.50 |
| Max. Negotiated Rate |
$5,090.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,214.80
|
| Rate for Payer: Cash Price |
$3,214.80
|
| Rate for Payer: Cash Price |
$3,214.80
|
| Rate for Payer: Cigna Commercial |
$4,554.30
|
| Rate for Payer: First Health Commercial |
$4,822.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,822.20
|
| Rate for Payer: GEHA Commercial |
$4,286.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,822.20
|
| Rate for Payer: Humana ChoiceCare |
$1,393.08
|
| Rate for Payer: Multiplan All |
$4,875.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,214.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,750.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,822.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,090.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,018.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,715.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,339.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,982.94
|
| Rate for Payer: Zelis Auto |
$2,143.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,679.00
|
|
|
IMPLT PLATE DR VOLAR 11 HL NAR 2.7 LT
|
Facility
|
IP
|
$5,358.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,143.20 |
| Max. Negotiated Rate |
$5,090.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,286.40
|
| Rate for Payer: Cash Price |
$3,214.80
|
| Rate for Payer: Cash Price |
$3,214.80
|
| Rate for Payer: Cigna Commercial |
$4,554.30
|
| Rate for Payer: First Health Commercial |
$4,822.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,822.20
|
| Rate for Payer: GEHA Commercial |
$3,750.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,822.20
|
| Rate for Payer: Multiplan All |
$4,875.78
|
| Rate for Payer: OMNI Networks Commercial |
$3,750.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,822.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,090.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,018.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,982.94
|
| Rate for Payer: Zelis Auto |
$2,143.20
|
|
|
IMPLT PLATE DR VOLAR L 14-HOLES
|
Facility
|
IP
|
$3,271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.40 |
| Max. Negotiated Rate |
$3,107.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,616.80
|
| Rate for Payer: Cash Price |
$1,962.60
|
| Rate for Payer: Cash Price |
$1,962.60
|
| Rate for Payer: Cigna Commercial |
$2,780.35
|
| Rate for Payer: First Health Commercial |
$2,943.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,943.90
|
| Rate for Payer: GEHA Commercial |
$2,289.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,943.90
|
| Rate for Payer: Multiplan All |
$2,976.61
|
| Rate for Payer: OMNI Networks Commercial |
$2,289.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,943.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,107.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,453.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,042.03
|
| Rate for Payer: Zelis Auto |
$1,308.40
|
|
|
IMPLT PLATE DR VOLAR L 14-HOLES
|
Facility
|
OP
|
$3,271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$817.75 |
| Max. Negotiated Rate |
$3,107.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,962.60
|
| Rate for Payer: Cash Price |
$1,962.60
|
| Rate for Payer: Cash Price |
$1,962.60
|
| Rate for Payer: Cigna Commercial |
$2,780.35
|
| Rate for Payer: First Health Commercial |
$2,943.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,943.90
|
| Rate for Payer: GEHA Commercial |
$2,616.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,943.90
|
| Rate for Payer: Humana ChoiceCare |
$850.46
|
| Rate for Payer: Multiplan All |
$2,976.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,962.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,289.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,943.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,107.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,453.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,878.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$817.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,042.03
|
| Rate for Payer: Zelis Auto |
$1,308.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,635.50
|
|
|
IMPLT PLATE DVR STANDARD ANATOMIC
|
Facility
|
IP
|
$3,658.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,463.20 |
| Max. Negotiated Rate |
$3,475.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,926.40
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$3,109.30
|
| Rate for Payer: First Health Commercial |
$3,292.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,292.20
|
| Rate for Payer: GEHA Commercial |
$2,560.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,292.20
|
| Rate for Payer: Multiplan All |
$3,328.78
|
| Rate for Payer: OMNI Networks Commercial |
$2,560.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,292.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,475.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,743.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,401.94
|
| Rate for Payer: Zelis Auto |
$1,463.20
|
|
|
IMPLT PLATE DVR STANDARD ANATOMIC
|
Facility
|
OP
|
$3,658.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.50 |
| Max. Negotiated Rate |
$3,475.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,194.80
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$3,109.30
|
| Rate for Payer: First Health Commercial |
$3,292.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,292.20
|
| Rate for Payer: GEHA Commercial |
$2,926.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,292.20
|
| Rate for Payer: Humana ChoiceCare |
$951.08
|
| Rate for Payer: Multiplan All |
$3,328.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,194.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,560.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,292.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,475.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,743.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,219.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$914.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,401.94
|
| Rate for Payer: Zelis Auto |
$1,463.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,829.00
|
|
|
IMPLT PLATE ELBOW LATERIAL POSTERIOR
|
Facility
|
IP
|
$2,987.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.96 |
| Max. Negotiated Rate |
$2,838.03 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,389.92
|
| Rate for Payer: Cash Price |
$1,792.44
|
| Rate for Payer: Cash Price |
$1,792.44
|
| Rate for Payer: Cigna Commercial |
$2,539.29
|
| Rate for Payer: First Health Commercial |
$2,688.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,688.66
|
| Rate for Payer: GEHA Commercial |
$2,091.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,688.66
|
| Rate for Payer: Multiplan All |
$2,718.53
|
| Rate for Payer: OMNI Networks Commercial |
$2,091.18
|
| Rate for Payer: One Health Plan PPO/POS |
$2,688.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,838.03
|
| Rate for Payer: Three Rivers Provider Network All |
$2,240.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,778.28
|
| Rate for Payer: Zelis Auto |
$1,194.96
|
|
|
IMPLT PLATE ELBOW LATERIAL POSTERIOR
|
Facility
|
OP
|
$2,987.40
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.85 |
| Max. Negotiated Rate |
$2,838.03 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,792.44
|
| Rate for Payer: Cash Price |
$1,792.44
|
| Rate for Payer: Cash Price |
$1,792.44
|
| Rate for Payer: Cigna Commercial |
$2,539.29
|
| Rate for Payer: First Health Commercial |
$2,688.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,688.66
|
| Rate for Payer: GEHA Commercial |
$2,389.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,688.66
|
| Rate for Payer: Humana ChoiceCare |
$776.72
|
| Rate for Payer: Multiplan All |
$2,718.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,792.44
|
| Rate for Payer: OMNI Networks Commercial |
$2,091.18
|
| Rate for Payer: One Health Plan PPO/POS |
$2,688.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,838.03
|
| Rate for Payer: Three Rivers Provider Network All |
$2,240.55
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,628.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$746.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,778.28
|
| Rate for Payer: Zelis Auto |
$1,194.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,493.70
|
|
|
IMPLT PLATE ELBOW MEDIAL
|
Facility
|
IP
|
$3,217.08
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.83 |
| Max. Negotiated Rate |
$3,056.23 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,573.66
|
| Rate for Payer: Cash Price |
$1,930.25
|
| Rate for Payer: Cash Price |
$1,930.25
|
| Rate for Payer: Cigna Commercial |
$2,734.52
|
| Rate for Payer: First Health Commercial |
$2,895.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,895.37
|
| Rate for Payer: GEHA Commercial |
$2,251.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,895.37
|
| Rate for Payer: Multiplan All |
$2,927.54
|
| Rate for Payer: OMNI Networks Commercial |
$2,251.96
|
| Rate for Payer: One Health Plan PPO/POS |
$2,895.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,056.23
|
| Rate for Payer: Three Rivers Provider Network All |
$2,412.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,991.88
|
| Rate for Payer: Zelis Auto |
$1,286.83
|
|
|
IMPLT PLATE ELBOW MEDIAL
|
Facility
|
OP
|
$3,217.08
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.27 |
| Max. Negotiated Rate |
$3,056.23 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,930.25
|
| Rate for Payer: Cash Price |
$1,930.25
|
| Rate for Payer: Cash Price |
$1,930.25
|
| Rate for Payer: Cigna Commercial |
$2,734.52
|
| Rate for Payer: First Health Commercial |
$2,895.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,895.37
|
| Rate for Payer: GEHA Commercial |
$2,573.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,895.37
|
| Rate for Payer: Humana ChoiceCare |
$836.44
|
| Rate for Payer: Multiplan All |
$2,927.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,930.25
|
| Rate for Payer: OMNI Networks Commercial |
$2,251.96
|
| Rate for Payer: One Health Plan PPO/POS |
$2,895.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,056.23
|
| Rate for Payer: Three Rivers Provider Network All |
$2,412.81
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,831.03
|
| Rate for Payer: United Healthcare Managed Medicaid |
$804.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,991.88
|
| Rate for Payer: Zelis Auto |
$1,286.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,608.54
|
|
|
IMPLT PLATE FEMUR 4 HOLE
|
Facility
|
OP
|
$7,609.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003068
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,902.25 |
| Max. Negotiated Rate |
$7,228.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,565.40
|
| Rate for Payer: Cash Price |
$4,565.40
|
| Rate for Payer: Cash Price |
$4,565.40
|
| Rate for Payer: Cigna Commercial |
$6,467.65
|
| Rate for Payer: First Health Commercial |
$6,848.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,848.10
|
| Rate for Payer: GEHA Commercial |
$6,087.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,848.10
|
| Rate for Payer: Humana ChoiceCare |
$1,978.34
|
| Rate for Payer: Multiplan All |
$6,924.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,565.40
|
| Rate for Payer: OMNI Networks Commercial |
$5,326.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,848.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,228.55
|
| Rate for Payer: Three Rivers Provider Network All |
$5,706.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,695.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,076.37
|
| Rate for Payer: Zelis Auto |
$3,043.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,804.50
|
|
|
IMPLT PLATE FEMUR 4 HOLE
|
Facility
|
IP
|
$7,609.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003068
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,043.60 |
| Max. Negotiated Rate |
$7,228.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,087.20
|
| Rate for Payer: Cash Price |
$4,565.40
|
| Rate for Payer: Cash Price |
$4,565.40
|
| Rate for Payer: Cigna Commercial |
$6,467.65
|
| Rate for Payer: First Health Commercial |
$6,848.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,848.10
|
| Rate for Payer: GEHA Commercial |
$5,326.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,848.10
|
| Rate for Payer: Multiplan All |
$6,924.19
|
| Rate for Payer: OMNI Networks Commercial |
$5,326.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,848.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,228.55
|
| Rate for Payer: Three Rivers Provider Network All |
$5,706.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,076.37
|
| Rate for Payer: Zelis Auto |
$3,043.60
|
|
|
IMPLT PLATE FEMUR 8 HOLE
|
Facility
|
IP
|
$7,927.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,170.80 |
| Max. Negotiated Rate |
$7,530.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,341.60
|
| Rate for Payer: Cash Price |
$4,756.20
|
| Rate for Payer: Cash Price |
$4,756.20
|
| Rate for Payer: Cigna Commercial |
$6,737.95
|
| Rate for Payer: First Health Commercial |
$7,134.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,134.30
|
| Rate for Payer: GEHA Commercial |
$5,548.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,134.30
|
| Rate for Payer: Multiplan All |
$7,213.57
|
| Rate for Payer: OMNI Networks Commercial |
$5,548.90
|
| Rate for Payer: One Health Plan PPO/POS |
$7,134.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,530.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5,945.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,372.11
|
| Rate for Payer: Zelis Auto |
$3,170.80
|
|
|
IMPLT PLATE FEMUR 8 HOLE
|
Facility
|
OP
|
$7,927.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,981.75 |
| Max. Negotiated Rate |
$7,530.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,756.20
|
| Rate for Payer: Cash Price |
$4,756.20
|
| Rate for Payer: Cash Price |
$4,756.20
|
| Rate for Payer: Cigna Commercial |
$6,737.95
|
| Rate for Payer: First Health Commercial |
$7,134.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,134.30
|
| Rate for Payer: GEHA Commercial |
$6,341.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,134.30
|
| Rate for Payer: Humana ChoiceCare |
$2,061.02
|
| Rate for Payer: Multiplan All |
$7,213.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,756.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,548.90
|
| Rate for Payer: One Health Plan PPO/POS |
$7,134.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,530.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5,945.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,975.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,372.11
|
| Rate for Payer: Zelis Auto |
$3,170.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,963.50
|
|
