|
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
|
|
|
IMPLT PLATE FIBULA LATERAL DISTAL 77MM
|
Facility
|
IP
|
$2,432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000322
|
|
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 LATERAL DISTAL 77MM
|
Facility
|
OP
|
$2,432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000322
|
|
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 STRAIGHT
|
Facility
|
IP
|
$3,124.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,249.60 |
| Max. Negotiated Rate |
$2,967.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,499.20
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cigna Commercial |
$2,655.40
|
| Rate for Payer: First Health Commercial |
$2,811.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,811.60
|
| Rate for Payer: GEHA Commercial |
$2,186.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,811.60
|
| Rate for Payer: Multiplan All |
$2,842.84
|
| Rate for Payer: OMNI Networks Commercial |
$2,186.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,811.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,967.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,343.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,905.32
|
| Rate for Payer: Zelis Auto |
$1,249.60
|
|
|
IMPLT PLATE FIBULA STRAIGHT
|
Facility
|
OP
|
$3,124.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$781.00 |
| Max. Negotiated Rate |
$2,967.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,874.40
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cigna Commercial |
$2,655.40
|
| Rate for Payer: First Health Commercial |
$2,811.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,811.60
|
| Rate for Payer: GEHA Commercial |
$2,499.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,811.60
|
| Rate for Payer: Humana ChoiceCare |
$812.24
|
| Rate for Payer: Multiplan All |
$2,842.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,874.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,186.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,811.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,967.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,343.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,749.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$781.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,905.32
|
| Rate for Payer: Zelis Auto |
$1,249.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,562.00
|
|
|
IMPLT PLATE FIBULA STRAIGHT 6-HOLE
|
Facility
|
OP
|
$2,376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.00 |
| Max. Negotiated Rate |
$2,257.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cigna Commercial |
$2,019.60
|
| Rate for Payer: First Health Commercial |
$2,138.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,138.40
|
| Rate for Payer: GEHA Commercial |
$1,900.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,138.40
|
| Rate for Payer: Humana ChoiceCare |
$617.76
|
| Rate for Payer: Multiplan All |
$2,162.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,425.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,663.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,138.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,257.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,782.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,090.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$594.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,209.68
|
| Rate for Payer: Zelis Auto |
$950.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,188.00
|
|
|
IMPLT PLATE FIBULA STRAIGHT 6-HOLE
|
Facility
|
IP
|
$2,376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.40 |
| Max. Negotiated Rate |
$2,257.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,900.80
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cigna Commercial |
$2,019.60
|
| Rate for Payer: First Health Commercial |
$2,138.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,138.40
|
| Rate for Payer: GEHA Commercial |
$1,663.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,138.40
|
| Rate for Payer: Multiplan All |
$2,162.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,663.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,138.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,257.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,782.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,209.68
|
| Rate for Payer: Zelis Auto |
$950.40
|
|
|
IMPLT PLATE FIBULA STRAIGHT HOLE
|
Facility
|
OP
|
$1,754.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.70 |
| Max. Negotiated Rate |
$1,667.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,052.88
|
| Rate for Payer: Cash Price |
$1,052.88
|
| Rate for Payer: Cash Price |
$1,052.88
|
| Rate for Payer: Cigna Commercial |
$1,491.58
|
| Rate for Payer: First Health Commercial |
$1,579.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,579.32
|
| Rate for Payer: GEHA Commercial |
$1,403.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,579.32
|
| Rate for Payer: Humana ChoiceCare |
$456.25
|
| Rate for Payer: Multiplan All |
$1,596.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,052.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,228.36
|
| Rate for Payer: One Health Plan PPO/POS |
$1,579.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,667.06
|
| Rate for Payer: Three Rivers Provider Network All |
$1,316.10
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,544.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$438.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,631.96
|
| Rate for Payer: Zelis Auto |
$701.92
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$877.40
|
|
|
IMPLT PLATE FIBULA STRAIGHT HOLE
|
Facility
|
IP
|
$1,754.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.92 |
| Max. Negotiated Rate |
$1,667.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,403.84
|
| Rate for Payer: Cash Price |
$1,052.88
|
| Rate for Payer: Cash Price |
$1,052.88
|
| Rate for Payer: Cigna Commercial |
$1,491.58
|
| Rate for Payer: First Health Commercial |
$1,579.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,579.32
|
| Rate for Payer: GEHA Commercial |
$1,228.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,579.32
|
| Rate for Payer: Multiplan All |
$1,596.87
|
| Rate for Payer: OMNI Networks Commercial |
$1,228.36
|
| Rate for Payer: One Health Plan PPO/POS |
$1,579.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,667.06
|
| Rate for Payer: Three Rivers Provider Network All |
$1,316.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,631.96
|
| Rate for Payer: Zelis Auto |
$701.92
|
|
|
IMPLT PLATE FOOT GOLDENBERG 2MM
|
Facility
|
OP
|
$897.00
|
|
|
Service Code
|
CPT L8613
|
| Hospital Charge Code |
7002493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.25 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.20
|
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cigna Commercial |
$762.45
|
| Rate for Payer: First Health Commercial |
$807.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$807.30
|
| Rate for Payer: GEHA Commercial |
$717.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$807.30
|
| Rate for Payer: Humana ChoiceCare |
$233.22
|
| Rate for Payer: Multiplan All |
$816.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.20
|
| Rate for Payer: OMNI Networks Commercial |
$627.90
|
| Rate for Payer: One Health Plan PPO/POS |
$807.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$852.15
|
| Rate for Payer: Three Rivers Provider Network All |
$672.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$789.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$834.21
|
| Rate for Payer: Zelis Auto |
$358.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$448.50
|
|
|
IMPLT PLATE FOOT GOLDENBERG 2MM
|
Facility
|
IP
|
$897.00
|
|
|
Service Code
|
CPT L8613
|
| Hospital Charge Code |
7002493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.80 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$717.60
|
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Cigna Commercial |
$762.45
|
| Rate for Payer: First Health Commercial |
$807.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$807.30
|
| Rate for Payer: GEHA Commercial |
$627.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$807.30
|
| Rate for Payer: Multiplan All |
$816.27
|
| Rate for Payer: OMNI Networks Commercial |
$627.90
|
| Rate for Payer: One Health Plan PPO/POS |
$807.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$852.15
|
| Rate for Payer: Three Rivers Provider Network All |
$672.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$834.21
|
| Rate for Payer: Zelis Auto |
$358.80
|
|
|
IMPLT PLATE FOREARM 6 HOLE 49300600
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$561.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Humana ChoiceCare |
$182.52
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$421.20
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$617.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$351.00
|
|
|
IMPLT PLATE FOREARM 6 HOLE 49300600
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.60
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$491.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
|
|
IMPLT PLATE FUSION RIGHT WRIST SMALL
|
Facility
|
OP
|
$3,821.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.25 |
| Max. Negotiated Rate |
$3,629.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,292.60
|
| Rate for Payer: Cash Price |
$2,292.60
|
| Rate for Payer: Cash Price |
$2,292.60
|
| Rate for Payer: Cigna Commercial |
$3,247.85
|
| Rate for Payer: First Health Commercial |
$3,438.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,438.90
|
| Rate for Payer: GEHA Commercial |
$3,056.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,438.90
|
| Rate for Payer: Humana ChoiceCare |
$993.46
|
| Rate for Payer: Multiplan All |
$3,477.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,292.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,674.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,438.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,629.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,865.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,362.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$955.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,553.53
|
| Rate for Payer: Zelis Auto |
$1,528.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,910.50
|
|
|
IMPLT PLATE FUSION RIGHT WRIST SMALL
|
Facility
|
IP
|
$3,821.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.40 |
| Max. Negotiated Rate |
$3,629.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,056.80
|
| Rate for Payer: Cash Price |
$2,292.60
|
| Rate for Payer: Cash Price |
$2,292.60
|
| Rate for Payer: Cigna Commercial |
$3,247.85
|
| Rate for Payer: First Health Commercial |
$3,438.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,438.90
|
| Rate for Payer: GEHA Commercial |
$2,674.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,438.90
|
| Rate for Payer: Multiplan All |
$3,477.11
|
| Rate for Payer: OMNI Networks Commercial |
$2,674.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,438.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,629.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,865.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,553.53
|
| Rate for Payer: Zelis Auto |
$1,528.40
|
|
|
IMPLT PLATE FUSION WRIST BENT SHORT
|
Facility
|
OP
|
$8,528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,132.00 |
| Max. Negotiated Rate |
$8,101.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,116.80
|
| Rate for Payer: Cash Price |
$5,116.80
|
| Rate for Payer: Cash Price |
$5,116.80
|
| Rate for Payer: Cigna Commercial |
$7,248.80
|
| Rate for Payer: First Health Commercial |
$7,675.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,675.20
|
| Rate for Payer: GEHA Commercial |
$6,822.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,675.20
|
| Rate for Payer: Humana ChoiceCare |
$2,217.28
|
| Rate for Payer: Multiplan All |
$7,760.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,116.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,969.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,675.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,101.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6,396.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,504.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,132.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,931.04
|
| Rate for Payer: Zelis Auto |
$3,411.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,264.00
|
|
|
IMPLT PLATE FUSION WRIST BENT SHORT
|
Facility
|
IP
|
$7,993.00
|
|
| Hospital Charge Code |
90061792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,197.20 |
| Max. Negotiated Rate |
$7,593.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,394.40
|
| Rate for Payer: Cash Price |
$4,795.80
|
| Rate for Payer: Cash Price |
$4,795.80
|
| Rate for Payer: Cigna Commercial |
$6,794.05
|
| Rate for Payer: First Health Commercial |
$7,193.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,193.70
|
| Rate for Payer: GEHA Commercial |
$5,595.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,193.70
|
| Rate for Payer: Multiplan All |
$7,273.63
|
| Rate for Payer: OMNI Networks Commercial |
$5,595.10
|
| Rate for Payer: One Health Plan PPO/POS |
$7,193.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,593.35
|
| Rate for Payer: Three Rivers Provider Network All |
$5,994.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,433.49
|
| Rate for Payer: Zelis Auto |
$3,197.20
|
|
|
IMPLT PLATE FUSION WRIST BENT SHORT
|
Facility
|
OP
|
$7,993.00
|
|
| Hospital Charge Code |
90061792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,998.25 |
| Max. Negotiated Rate |
$7,593.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,795.80
|
| Rate for Payer: Cash Price |
$4,795.80
|
| Rate for Payer: Cash Price |
$4,795.80
|
| Rate for Payer: Cigna Commercial |
$6,794.05
|
| Rate for Payer: First Health Commercial |
$7,193.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,193.70
|
| Rate for Payer: GEHA Commercial |
$6,394.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,193.70
|
| Rate for Payer: Humana ChoiceCare |
$2,078.18
|
| Rate for Payer: Multiplan All |
$7,273.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,795.80
|
| Rate for Payer: OMNI Networks Commercial |
$5,595.10
|
| Rate for Payer: One Health Plan PPO/POS |
$7,193.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,593.35
|
| Rate for Payer: Three Rivers Provider Network All |
$5,994.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,033.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,998.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,433.49
|
| Rate for Payer: Zelis Auto |
$3,197.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,996.50
|
|
|
IMPLT PLATE FUSION WRIST BENT SHORT
|
Facility
|
IP
|
$8,528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,411.20 |
| Max. Negotiated Rate |
$8,101.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,822.40
|
| Rate for Payer: Cash Price |
$5,116.80
|
| Rate for Payer: Cash Price |
$5,116.80
|
| Rate for Payer: Cigna Commercial |
$7,248.80
|
| Rate for Payer: First Health Commercial |
$7,675.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,675.20
|
| Rate for Payer: GEHA Commercial |
$5,969.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,675.20
|
| Rate for Payer: Multiplan All |
$7,760.48
|
| Rate for Payer: OMNI Networks Commercial |
$5,969.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7,675.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,101.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6,396.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,931.04
|
| Rate for Payer: Zelis Auto |
$3,411.20
|
|
|
IMPLT PLATE FUSION WRIST STRAIGHT
|
Facility
|
OP
|
$8,582.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,145.50 |
| Max. Negotiated Rate |
$8,152.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,149.20
|
| Rate for Payer: Cash Price |
$5,149.20
|
| Rate for Payer: Cash Price |
$5,149.20
|
| Rate for Payer: Cigna Commercial |
$7,294.70
|
| Rate for Payer: First Health Commercial |
$7,723.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,723.80
|
| Rate for Payer: GEHA Commercial |
$6,865.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,723.80
|
| Rate for Payer: Humana ChoiceCare |
$2,231.32
|
| Rate for Payer: Multiplan All |
$7,809.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,149.20
|
| Rate for Payer: OMNI Networks Commercial |
$6,007.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,723.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,152.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,436.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,552.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,145.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,981.26
|
| Rate for Payer: Zelis Auto |
$3,432.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,291.00
|
|
|
IMPLT PLATE FUSION WRIST STRAIGHT
|
Facility
|
IP
|
$8,582.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,432.80 |
| Max. Negotiated Rate |
$8,152.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,865.60
|
| Rate for Payer: Cash Price |
$5,149.20
|
| Rate for Payer: Cash Price |
$5,149.20
|
| Rate for Payer: Cigna Commercial |
$7,294.70
|
| Rate for Payer: First Health Commercial |
$7,723.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,723.80
|
| Rate for Payer: GEHA Commercial |
$6,007.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,723.80
|
| Rate for Payer: Multiplan All |
$7,809.62
|
| Rate for Payer: OMNI Networks Commercial |
$6,007.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,723.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,152.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,436.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,981.26
|
| Rate for Payer: Zelis Auto |
$3,432.80
|
|
|
IMPLT PLATE GRIP TROCHANTERIC MEDIUM
|
Facility
|
OP
|
$3,797.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.25 |
| Max. Negotiated Rate |
$3,607.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,278.20
|
| Rate for Payer: Cash Price |
$2,278.20
|
| Rate for Payer: Cash Price |
$2,278.20
|
| Rate for Payer: Cigna Commercial |
$3,227.45
|
| Rate for Payer: First Health Commercial |
$3,417.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,417.30
|
| Rate for Payer: GEHA Commercial |
$3,037.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,417.30
|
| Rate for Payer: Humana ChoiceCare |
$987.22
|
| Rate for Payer: Multiplan All |
$3,455.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,278.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,657.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,417.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,607.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,847.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,341.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$949.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,531.21
|
| Rate for Payer: Zelis Auto |
$1,518.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,898.50
|
|
|
IMPLT PLATE GRIP TROCHANTERIC MEDIUM
|
Facility
|
IP
|
$3,797.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,518.80 |
| Max. Negotiated Rate |
$3,607.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,037.60
|
| Rate for Payer: Cash Price |
$2,278.20
|
| Rate for Payer: Cash Price |
$2,278.20
|
| Rate for Payer: Cigna Commercial |
$3,227.45
|
| Rate for Payer: First Health Commercial |
$3,417.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,417.30
|
| Rate for Payer: GEHA Commercial |
$2,657.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,417.30
|
| Rate for Payer: Multiplan All |
$3,455.27
|
| Rate for Payer: OMNI Networks Commercial |
$2,657.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,417.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,607.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,847.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,531.21
|
| Rate for Payer: Zelis Auto |
$1,518.80
|
|
|
IMPLT PLATE GRIP TROCHANTERIC W/2 CABLES
|
Facility
|
IP
|
$3,910.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$3,714.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,128.00
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cigna Commercial |
$3,323.50
|
| Rate for Payer: First Health Commercial |
$3,519.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,519.00
|
| Rate for Payer: GEHA Commercial |
$2,737.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,519.00
|
| Rate for Payer: Multiplan All |
$3,558.10
|
| Rate for Payer: OMNI Networks Commercial |
$2,737.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,519.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,714.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,932.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,636.30
|
| Rate for Payer: Zelis Auto |
$1,564.00
|
|
|
IMPLT PLATE GRIP TROCHANTERIC W/2 CABLES
|
Facility
|
OP
|
$3,910.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.50 |
| Max. Negotiated Rate |
$3,714.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,346.00
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cigna Commercial |
$3,323.50
|
| Rate for Payer: First Health Commercial |
$3,519.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,519.00
|
| Rate for Payer: GEHA Commercial |
$3,128.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,519.00
|
| Rate for Payer: Humana ChoiceCare |
$1,016.60
|
| Rate for Payer: Multiplan All |
$3,558.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,346.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,737.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,519.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,714.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,932.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,440.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$977.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,636.30
|
| Rate for Payer: Zelis Auto |
$1,564.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,955.00
|
|
