|
IMPLT PLATE FEMUR DISTAL LEFT
|
Facility
|
OP
|
$7,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,974.00 |
| Max. Negotiated Rate |
$7,501.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,737.60
|
| Rate for Payer: Cash Price |
$4,737.60
|
| Rate for Payer: Cash Price |
$4,737.60
|
| Rate for Payer: Cigna Commercial |
$6,711.60
|
| Rate for Payer: First Health Commercial |
$7,106.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,106.40
|
| Rate for Payer: GEHA Commercial |
$6,316.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,106.40
|
| Rate for Payer: Humana ChoiceCare |
$2,052.96
|
| Rate for Payer: Multiplan All |
$7,185.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,737.60
|
| Rate for Payer: OMNI Networks Commercial |
$5,527.20
|
| Rate for Payer: One Health Plan PPO/POS |
$7,106.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,501.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,922.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,948.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,974.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,343.28
|
| Rate for Payer: Zelis Auto |
$3,158.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,948.00
|
|
|
IMPLT PLATE FEMUR DISTAL LEFT
|
Facility
|
IP
|
$7,896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,158.40 |
| Max. Negotiated Rate |
$7,501.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,316.80
|
| Rate for Payer: Cash Price |
$4,737.60
|
| Rate for Payer: Cash Price |
$4,737.60
|
| Rate for Payer: Cigna Commercial |
$6,711.60
|
| Rate for Payer: First Health Commercial |
$7,106.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,106.40
|
| Rate for Payer: GEHA Commercial |
$5,527.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,106.40
|
| Rate for Payer: Multiplan All |
$7,185.36
|
| Rate for Payer: OMNI Networks Commercial |
$5,527.20
|
| Rate for Payer: One Health Plan PPO/POS |
$7,106.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,501.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,922.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,343.28
|
| Rate for Payer: Zelis Auto |
$3,158.40
|
|
|
IMPLT PLATE FEMUR LATERAL
|
Facility
|
IP
|
$7,400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,960.00 |
| Max. Negotiated Rate |
$7,030.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,920.00
|
| Rate for Payer: Cash Price |
$4,440.00
|
| Rate for Payer: Cash Price |
$4,440.00
|
| Rate for Payer: Cigna Commercial |
$6,290.00
|
| Rate for Payer: First Health Commercial |
$6,660.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,660.00
|
| Rate for Payer: GEHA Commercial |
$5,180.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,660.00
|
| Rate for Payer: Multiplan All |
$6,734.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,180.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,660.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,030.00
|
| Rate for Payer: Three Rivers Provider Network All |
$5,550.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,882.00
|
| Rate for Payer: Zelis Auto |
$2,960.00
|
|
|
IMPLT PLATE FEMUR LATERAL
|
Facility
|
OP
|
$7,400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.00 |
| Max. Negotiated Rate |
$7,030.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,440.00
|
| Rate for Payer: Cash Price |
$4,440.00
|
| Rate for Payer: Cash Price |
$4,440.00
|
| Rate for Payer: Cigna Commercial |
$6,290.00
|
| Rate for Payer: First Health Commercial |
$6,660.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,660.00
|
| Rate for Payer: GEHA Commercial |
$5,920.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,660.00
|
| Rate for Payer: Humana ChoiceCare |
$1,924.00
|
| Rate for Payer: Multiplan All |
$6,734.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,440.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,180.00
|
| Rate for Payer: One Health Plan PPO/POS |
$6,660.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,030.00
|
| Rate for Payer: Three Rivers Provider Network All |
$5,550.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,512.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,850.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,882.00
|
| Rate for Payer: Zelis Auto |
$2,960.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,700.00
|
|
|
IMPLT PLATE FEMUR LATERAL DISTAL 12 HOLE
|
Facility
|
IP
|
$8,247.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,298.80 |
| Max. Negotiated Rate |
$7,834.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,597.60
|
| Rate for Payer: Cash Price |
$4,948.20
|
| Rate for Payer: Cash Price |
$4,948.20
|
| Rate for Payer: Cigna Commercial |
$7,009.95
|
| Rate for Payer: First Health Commercial |
$7,422.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,422.30
|
| Rate for Payer: GEHA Commercial |
$5,772.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,422.30
|
| Rate for Payer: Multiplan All |
$7,504.77
|
| Rate for Payer: OMNI Networks Commercial |
$5,772.90
|
| Rate for Payer: One Health Plan PPO/POS |
$7,422.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,834.65
|
| Rate for Payer: Three Rivers Provider Network All |
$6,185.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,669.71
|
| Rate for Payer: Zelis Auto |
$3,298.80
|
|
|
IMPLT PLATE FEMUR LATERAL DISTAL 12 HOLE
|
Facility
|
OP
|
$8,247.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,061.75 |
| Max. Negotiated Rate |
$7,834.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,948.20
|
| Rate for Payer: Cash Price |
$4,948.20
|
| Rate for Payer: Cash Price |
$4,948.20
|
| Rate for Payer: Cigna Commercial |
$7,009.95
|
| Rate for Payer: First Health Commercial |
$7,422.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,422.30
|
| Rate for Payer: GEHA Commercial |
$6,597.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,422.30
|
| Rate for Payer: Humana ChoiceCare |
$2,144.22
|
| Rate for Payer: Multiplan All |
$7,504.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,948.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,772.90
|
| Rate for Payer: One Health Plan PPO/POS |
$7,422.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,834.65
|
| Rate for Payer: Three Rivers Provider Network All |
$6,185.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,257.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,061.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,669.71
|
| Rate for Payer: Zelis Auto |
$3,298.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,123.50
|
|
|
IMPLT PLATE FEMUR LT 12 HOLE 274MM
|
Facility
|
OP
|
$8,247.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,061.75 |
| Max. Negotiated Rate |
$7,834.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,948.20
|
| Rate for Payer: Cash Price |
$4,948.20
|
| Rate for Payer: Cash Price |
$4,948.20
|
| Rate for Payer: Cigna Commercial |
$7,009.95
|
| Rate for Payer: First Health Commercial |
$7,422.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,422.30
|
| Rate for Payer: GEHA Commercial |
$6,597.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,422.30
|
| Rate for Payer: Humana ChoiceCare |
$2,144.22
|
| Rate for Payer: Multiplan All |
$7,504.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,948.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,772.90
|
| Rate for Payer: One Health Plan PPO/POS |
$7,422.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,834.65
|
| Rate for Payer: Three Rivers Provider Network All |
$6,185.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,257.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,061.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,669.71
|
| Rate for Payer: Zelis Auto |
$3,298.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,123.50
|
|
|
IMPLT PLATE FEMUR LT 12 HOLE 274MM
|
Facility
|
IP
|
$8,247.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,298.80 |
| Max. Negotiated Rate |
$7,834.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,597.60
|
| Rate for Payer: Cash Price |
$4,948.20
|
| Rate for Payer: Cash Price |
$4,948.20
|
| Rate for Payer: Cigna Commercial |
$7,009.95
|
| Rate for Payer: First Health Commercial |
$7,422.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,422.30
|
| Rate for Payer: GEHA Commercial |
$5,772.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,422.30
|
| Rate for Payer: Multiplan All |
$7,504.77
|
| Rate for Payer: OMNI Networks Commercial |
$5,772.90
|
| Rate for Payer: One Health Plan PPO/POS |
$7,422.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,834.65
|
| Rate for Payer: Three Rivers Provider Network All |
$6,185.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,669.71
|
| Rate for Payer: Zelis Auto |
$3,298.80
|
|
|
IMPLT PLATE FIBULA
|
Facility
|
OP
|
$2,293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.25 |
| Max. Negotiated Rate |
$2,178.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,375.80
|
| Rate for Payer: Cash Price |
$1,375.80
|
| Rate for Payer: Cash Price |
$1,375.80
|
| Rate for Payer: Cigna Commercial |
$1,949.05
|
| Rate for Payer: First Health Commercial |
$2,063.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,063.70
|
| Rate for Payer: GEHA Commercial |
$1,834.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,063.70
|
| Rate for Payer: Humana ChoiceCare |
$596.18
|
| Rate for Payer: Multiplan All |
$2,086.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,375.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,605.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,063.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,178.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,719.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,017.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$573.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,132.49
|
| Rate for Payer: Zelis Auto |
$917.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,146.50
|
|
|
IMPLT PLATE FIBULA
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006380
|
|
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 FIBULA
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006380
|
|
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 FIBULA
|
Facility
|
IP
|
$2,293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$917.20 |
| Max. Negotiated Rate |
$2,178.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,834.40
|
| Rate for Payer: Cash Price |
$1,375.80
|
| Rate for Payer: Cash Price |
$1,375.80
|
| Rate for Payer: Cigna Commercial |
$1,949.05
|
| Rate for Payer: First Health Commercial |
$2,063.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,063.70
|
| Rate for Payer: GEHA Commercial |
$1,605.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,063.70
|
| Rate for Payer: Multiplan All |
$2,086.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,605.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,063.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,178.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,719.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,132.49
|
| Rate for Payer: Zelis Auto |
$917.20
|
|
|
IMPLT PLATE FIBULA 2.7/3.5 EVOS 5H L 81M
|
Facility
|
IP
|
$3,121.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.40 |
| Max. Negotiated Rate |
$2,964.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,496.80
|
| Rate for Payer: Cash Price |
$1,872.60
|
| Rate for Payer: Cash Price |
$1,872.60
|
| Rate for Payer: Cigna Commercial |
$2,652.85
|
| Rate for Payer: First Health Commercial |
$2,808.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,808.90
|
| Rate for Payer: GEHA Commercial |
$2,184.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,808.90
|
| Rate for Payer: Multiplan All |
$2,840.11
|
| Rate for Payer: OMNI Networks Commercial |
$2,184.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,808.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,964.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,340.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,902.53
|
| Rate for Payer: Zelis Auto |
$1,248.40
|
|
|
IMPLT PLATE FIBULA 2.7/3.5 EVOS 5H L 81M
|
Facility
|
OP
|
$3,121.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.25 |
| Max. Negotiated Rate |
$2,964.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,872.60
|
| Rate for Payer: Cash Price |
$1,872.60
|
| Rate for Payer: Cash Price |
$1,872.60
|
| Rate for Payer: Cigna Commercial |
$2,652.85
|
| Rate for Payer: First Health Commercial |
$2,808.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,808.90
|
| Rate for Payer: GEHA Commercial |
$2,496.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,808.90
|
| Rate for Payer: Humana ChoiceCare |
$811.46
|
| Rate for Payer: Multiplan All |
$2,840.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,872.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,184.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,808.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,964.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,340.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,746.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$780.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,902.53
|
| Rate for Payer: Zelis Auto |
$1,248.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,560.50
|
|
|
IMPLT PLATE FIBULA 3.5MMX83
|
Facility
|
IP
|
$2,547.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.80 |
| Max. Negotiated Rate |
$2,419.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,037.60
|
| Rate for Payer: Cash Price |
$1,528.20
|
| Rate for Payer: Cash Price |
$1,528.20
|
| Rate for Payer: Cigna Commercial |
$2,164.95
|
| Rate for Payer: First Health Commercial |
$2,292.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,292.30
|
| Rate for Payer: GEHA Commercial |
$1,782.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,292.30
|
| Rate for Payer: Multiplan All |
$2,317.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,782.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,292.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,419.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,910.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,368.71
|
| Rate for Payer: Zelis Auto |
$1,018.80
|
|
|
IMPLT PLATE FIBULA 3.5MMX83
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$636.75 |
| Max. Negotiated Rate |
$2,419.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,528.20
|
| Rate for Payer: Cash Price |
$1,528.20
|
| Rate for Payer: Cash Price |
$1,528.20
|
| Rate for Payer: Cigna Commercial |
$2,164.95
|
| Rate for Payer: First Health Commercial |
$2,292.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,292.30
|
| Rate for Payer: GEHA Commercial |
$2,037.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,292.30
|
| Rate for Payer: Humana ChoiceCare |
$662.22
|
| Rate for Payer: Multiplan All |
$2,317.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,528.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,782.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,292.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,419.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,910.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,241.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$636.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,368.71
|
| Rate for Payer: Zelis Auto |
$1,018.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,273.50
|
|
|
IMPLT PLATE FIBULA 7HOLE
|
Facility
|
OP
|
$2,450.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.54 |
| Max. Negotiated Rate |
$2,327.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,470.10
|
| Rate for Payer: Cash Price |
$1,470.10
|
| Rate for Payer: Cash Price |
$1,470.10
|
| Rate for Payer: Cigna Commercial |
$2,082.64
|
| Rate for Payer: First Health Commercial |
$2,205.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,205.14
|
| Rate for Payer: GEHA Commercial |
$1,960.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,205.14
|
| Rate for Payer: Humana ChoiceCare |
$637.04
|
| Rate for Payer: Multiplan All |
$2,229.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,470.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,715.11
|
| Rate for Payer: One Health Plan PPO/POS |
$2,205.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,327.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,837.62
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,156.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$612.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,278.65
|
| Rate for Payer: Zelis Auto |
$980.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,225.08
|
|
|
IMPLT PLATE FIBULA 7HOLE
|
Facility
|
IP
|
$2,450.16
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.06 |
| Max. Negotiated Rate |
$2,327.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,960.13
|
| Rate for Payer: Cash Price |
$1,470.10
|
| Rate for Payer: Cash Price |
$1,470.10
|
| Rate for Payer: Cigna Commercial |
$2,082.64
|
| Rate for Payer: First Health Commercial |
$2,205.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,205.14
|
| Rate for Payer: GEHA Commercial |
$1,715.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,205.14
|
| Rate for Payer: Multiplan All |
$2,229.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,715.11
|
| Rate for Payer: One Health Plan PPO/POS |
$2,205.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,327.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,837.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,278.65
|
| Rate for Payer: Zelis Auto |
$980.06
|
|
|
IMPLT PLATE FIBULA 8 HOLE
|
Facility
|
OP
|
$2,644.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.00 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$2,115.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| Rate for Payer: Humana ChoiceCare |
$687.44
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,586.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,326.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$661.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,322.00
|
|
|
IMPLT PLATE FIBULA 8 HOLE
|
Facility
|
IP
|
$2,644.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,057.60 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,115.20
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$1,850.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
|
|
IMPLT PLATE FIBULA HOLE 4
|
Facility
|
OP
|
$2,432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.00 |
| Max. Negotiated Rate |
$2,310.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,459.20
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cigna Commercial |
$2,067.20
|
| Rate for Payer: First Health Commercial |
$2,188.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,188.80
|
| Rate for Payer: GEHA Commercial |
$1,945.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,188.80
|
| Rate for Payer: Humana ChoiceCare |
$632.32
|
| Rate for Payer: Multiplan All |
$2,213.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,459.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,702.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,188.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,310.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,824.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,140.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$608.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,261.76
|
| Rate for Payer: Zelis Auto |
$972.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,216.00
|
|
|
IMPLT PLATE FIBULA HOLE 4
|
Facility
|
IP
|
$2,432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.80 |
| Max. Negotiated Rate |
$2,310.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,945.60
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cigna Commercial |
$2,067.20
|
| Rate for Payer: First Health Commercial |
$2,188.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,188.80
|
| Rate for Payer: GEHA Commercial |
$1,702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,188.80
|
| Rate for Payer: Multiplan All |
$2,213.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,702.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,188.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,310.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,824.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,261.76
|
| Rate for Payer: Zelis Auto |
$972.80
|
|
|
IMPLT PLATE FIBULA HOLE 6
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,371.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cigna Commercial |
$2,121.60
|
| Rate for Payer: First Health Commercial |
$2,246.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,246.40
|
| Rate for Payer: GEHA Commercial |
$1,996.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,246.40
|
| Rate for Payer: Humana ChoiceCare |
$648.96
|
| Rate for Payer: Multiplan All |
$2,271.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,497.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,747.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,246.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,371.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,872.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,196.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$624.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,321.28
|
| Rate for Payer: Zelis Auto |
$998.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,248.00
|
|
|
IMPLT PLATE FIBULA HOLE 6
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.40 |
| Max. Negotiated Rate |
$2,371.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,996.80
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cigna Commercial |
$2,121.60
|
| Rate for Payer: First Health Commercial |
$2,246.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,246.40
|
| Rate for Payer: GEHA Commercial |
$1,747.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,246.40
|
| Rate for Payer: Multiplan All |
$2,271.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,747.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,246.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,371.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,872.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,321.28
|
| Rate for Payer: Zelis Auto |
$998.40
|
|
|
IMPLT PLATE FIBULA HOLE 9
|
Facility
|
IP
|
$2,644.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,057.60 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,115.20
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$1,850.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
|
