|
IMPLT PLATE HAND ROTATION HOLE 5
|
Facility
|
IP
|
$2,172.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.80 |
| Max. Negotiated Rate |
$2,063.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,737.60
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cigna Commercial |
$1,846.20
|
| Rate for Payer: First Health Commercial |
$1,954.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,954.80
|
| Rate for Payer: GEHA Commercial |
$1,520.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,954.80
|
| Rate for Payer: Multiplan All |
$1,976.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,520.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,954.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,063.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,629.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,019.96
|
| Rate for Payer: Zelis Auto |
$868.80
|
|
|
IMPLT PLATE HAND ROTATION HOLE 5
|
Facility
|
OP
|
$2,172.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$2,063.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cigna Commercial |
$1,846.20
|
| Rate for Payer: First Health Commercial |
$1,954.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,954.80
|
| Rate for Payer: GEHA Commercial |
$1,737.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,954.80
|
| Rate for Payer: Humana ChoiceCare |
$564.72
|
| Rate for Payer: Multiplan All |
$1,976.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,303.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,520.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,954.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,063.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,629.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,911.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$543.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,019.96
|
| Rate for Payer: Zelis Auto |
$868.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,086.00
|
|
|
IMPLT PLATE HOLE 10
|
Facility
|
OP
|
$8,087.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.75 |
| Max. Negotiated Rate |
$7,682.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,852.20
|
| Rate for Payer: Cash Price |
$4,852.20
|
| Rate for Payer: Cash Price |
$4,852.20
|
| Rate for Payer: Cigna Commercial |
$6,873.95
|
| Rate for Payer: First Health Commercial |
$7,278.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,278.30
|
| Rate for Payer: GEHA Commercial |
$6,469.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,278.30
|
| Rate for Payer: Humana ChoiceCare |
$2,102.62
|
| Rate for Payer: Multiplan All |
$7,359.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,852.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,660.90
|
| Rate for Payer: One Health Plan PPO/POS |
$7,278.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,682.65
|
| Rate for Payer: Three Rivers Provider Network All |
$6,065.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,116.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,021.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,520.91
|
| Rate for Payer: Zelis Auto |
$3,234.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,043.50
|
|
|
IMPLT PLATE HOLE 10
|
Facility
|
IP
|
$8,087.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,234.80 |
| Max. Negotiated Rate |
$7,682.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,469.60
|
| Rate for Payer: Cash Price |
$4,852.20
|
| Rate for Payer: Cash Price |
$4,852.20
|
| Rate for Payer: Cigna Commercial |
$6,873.95
|
| Rate for Payer: First Health Commercial |
$7,278.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,278.30
|
| Rate for Payer: GEHA Commercial |
$5,660.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,278.30
|
| Rate for Payer: Multiplan All |
$7,359.17
|
| Rate for Payer: OMNI Networks Commercial |
$5,660.90
|
| Rate for Payer: One Health Plan PPO/POS |
$7,278.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,682.65
|
| Rate for Payer: Three Rivers Provider Network All |
$6,065.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,520.91
|
| Rate for Payer: Zelis Auto |
$3,234.80
|
|
|
IMPLT PLATE HOLE 4HL VARIAX
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.80 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,121.60
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$981.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
|
|
IMPLT PLATE HOLE 4HL VARIAX
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.50 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$1,121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Humana ChoiceCare |
$364.52
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$841.20
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,233.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$350.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$701.00
|
|
|
IMPLT PLATE HOLE 5
|
Facility
|
OP
|
$2,803.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.75 |
| Max. Negotiated Rate |
$2,662.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,681.80
|
| Rate for Payer: Cash Price |
$1,681.80
|
| Rate for Payer: Cash Price |
$1,681.80
|
| Rate for Payer: Cigna Commercial |
$2,382.55
|
| Rate for Payer: First Health Commercial |
$2,522.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,522.70
|
| Rate for Payer: GEHA Commercial |
$2,242.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,522.70
|
| Rate for Payer: Humana ChoiceCare |
$728.78
|
| Rate for Payer: Multiplan All |
$2,550.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,681.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,962.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,522.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,662.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,102.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,466.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$700.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,606.79
|
| Rate for Payer: Zelis Auto |
$1,121.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,401.50
|
|
|
IMPLT PLATE HOLE 5
|
Facility
|
IP
|
$2,803.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.20 |
| Max. Negotiated Rate |
$2,662.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,242.40
|
| Rate for Payer: Cash Price |
$1,681.80
|
| Rate for Payer: Cash Price |
$1,681.80
|
| Rate for Payer: Cigna Commercial |
$2,382.55
|
| Rate for Payer: First Health Commercial |
$2,522.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,522.70
|
| Rate for Payer: GEHA Commercial |
$1,962.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,522.70
|
| Rate for Payer: Multiplan All |
$2,550.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,962.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,522.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,662.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,102.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,606.79
|
| Rate for Payer: Zelis Auto |
$1,121.20
|
|
|
IMPLT PLATE HOLE 5HL VARIAX
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.40 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,420.80
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$1,509.60
|
| Rate for Payer: First Health Commercial |
$1,598.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,598.40
|
| Rate for Payer: GEHA Commercial |
$1,243.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,598.40
|
| Rate for Payer: Multiplan All |
$1,616.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,243.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,598.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,687.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,332.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,651.68
|
| Rate for Payer: Zelis Auto |
$710.40
|
|
|
IMPLT PLATE HOLE 5HL VARIAX
|
Facility
|
OP
|
$1,776.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.00 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$1,509.60
|
| Rate for Payer: First Health Commercial |
$1,598.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,598.40
|
| Rate for Payer: GEHA Commercial |
$1,420.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,598.40
|
| Rate for Payer: Humana ChoiceCare |
$461.76
|
| Rate for Payer: Multiplan All |
$1,616.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,065.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,243.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,598.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,687.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,332.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,562.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$444.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,651.68
|
| Rate for Payer: Zelis Auto |
$710.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$888.00
|
|
|
IMPLT PLATE HOLE 6 TUBULAR 241.36
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.40 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.80
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$399.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
|
|
IMPLT PLATE HOLE 6 TUBULAR 241.36
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.75 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$456.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Humana ChoiceCare |
$148.46
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$342.60
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$502.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$285.50
|
|
|
IMPLT PLATE HOLE EIGHT
|
Facility
|
OP
|
$4,048.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.00 |
| Max. Negotiated Rate |
$3,845.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cigna Commercial |
$3,440.80
|
| Rate for Payer: First Health Commercial |
$3,643.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,643.20
|
| Rate for Payer: GEHA Commercial |
$3,238.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,643.20
|
| Rate for Payer: Humana ChoiceCare |
$1,052.48
|
| Rate for Payer: Multiplan All |
$3,683.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,428.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,833.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,643.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,845.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,036.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,562.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,012.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,764.64
|
| Rate for Payer: Zelis Auto |
$1,619.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,024.00
|
|
|
IMPLT PLATE HOLE EIGHT
|
Facility
|
IP
|
$4,048.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,619.20 |
| Max. Negotiated Rate |
$3,845.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,238.40
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cigna Commercial |
$3,440.80
|
| Rate for Payer: First Health Commercial |
$3,643.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,643.20
|
| Rate for Payer: GEHA Commercial |
$2,833.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,643.20
|
| Rate for Payer: Multiplan All |
$3,683.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,833.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,643.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,845.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,036.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,764.64
|
| Rate for Payer: Zelis Auto |
$1,619.20
|
|
|
IMPLT PLATE HOLE FOUR
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.80 |
| Max. Negotiated Rate |
$3,564.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,001.60
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cigna Commercial |
$3,189.20
|
| Rate for Payer: First Health Commercial |
$3,376.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,376.80
|
| Rate for Payer: GEHA Commercial |
$2,626.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,376.80
|
| Rate for Payer: Multiplan All |
$3,414.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,626.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,376.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,564.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,814.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,489.36
|
| Rate for Payer: Zelis Auto |
$1,500.80
|
|
|
IMPLT PLATE HOLE FOUR
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$3,564.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cigna Commercial |
$3,189.20
|
| Rate for Payer: First Health Commercial |
$3,376.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,376.80
|
| Rate for Payer: GEHA Commercial |
$3,001.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,376.80
|
| Rate for Payer: Humana ChoiceCare |
$975.52
|
| Rate for Payer: Multiplan All |
$3,414.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,251.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,626.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,376.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,564.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,814.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,301.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$938.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,489.36
|
| Rate for Payer: Zelis Auto |
$1,500.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,876.00
|
|
|
IMPLT PLATE HOLE TWO 20MM
|
Facility
|
OP
|
$4,148.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.00 |
| Max. Negotiated Rate |
$3,940.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,488.80
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cigna Commercial |
$3,525.80
|
| Rate for Payer: First Health Commercial |
$3,733.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,733.20
|
| Rate for Payer: GEHA Commercial |
$3,318.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,733.20
|
| Rate for Payer: Humana ChoiceCare |
$1,078.48
|
| Rate for Payer: Multiplan All |
$3,774.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,488.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,903.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,733.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,940.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,111.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,650.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,037.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,857.64
|
| Rate for Payer: Zelis Auto |
$1,659.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,074.00
|
|
|
IMPLT PLATE HOLE TWO 20MM
|
Facility
|
IP
|
$4,148.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.20 |
| Max. Negotiated Rate |
$3,940.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,318.40
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cigna Commercial |
$3,525.80
|
| Rate for Payer: First Health Commercial |
$3,733.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,733.20
|
| Rate for Payer: GEHA Commercial |
$2,903.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,733.20
|
| Rate for Payer: Multiplan All |
$3,774.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,903.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,733.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,940.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,111.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,857.64
|
| Rate for Payer: Zelis Auto |
$1,659.20
|
|
|
IMPLT PLATE HOLE TWO 25MM
|
Facility
|
IP
|
$4,148.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.20 |
| Max. Negotiated Rate |
$3,940.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,318.40
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cigna Commercial |
$3,525.80
|
| Rate for Payer: First Health Commercial |
$3,733.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,733.20
|
| Rate for Payer: GEHA Commercial |
$2,903.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,733.20
|
| Rate for Payer: Multiplan All |
$3,774.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,903.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,733.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,940.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,111.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,857.64
|
| Rate for Payer: Zelis Auto |
$1,659.20
|
|
|
IMPLT PLATE HOLE TWO 25MM
|
Facility
|
OP
|
$4,148.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.00 |
| Max. Negotiated Rate |
$3,940.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,488.80
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cigna Commercial |
$3,525.80
|
| Rate for Payer: First Health Commercial |
$3,733.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,733.20
|
| Rate for Payer: GEHA Commercial |
$3,318.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,733.20
|
| Rate for Payer: Humana ChoiceCare |
$1,078.48
|
| Rate for Payer: Multiplan All |
$3,774.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,488.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,903.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,733.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,940.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,111.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,650.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,037.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,857.64
|
| Rate for Payer: Zelis Auto |
$1,659.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,074.00
|
|
|
IMPLT PLATE HUMERUS 4 HOLE
|
Facility
|
OP
|
$3,503.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.75 |
| Max. Negotiated Rate |
$3,327.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,101.80
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$2,977.55
|
| Rate for Payer: First Health Commercial |
$3,152.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,152.70
|
| Rate for Payer: GEHA Commercial |
$2,802.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,152.70
|
| Rate for Payer: Humana ChoiceCare |
$910.78
|
| Rate for Payer: Multiplan All |
$3,187.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,101.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,452.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,152.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,327.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,627.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,082.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$875.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,257.79
|
| Rate for Payer: Zelis Auto |
$1,401.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,751.50
|
|
|
IMPLT PLATE HUMERUS 4 HOLE
|
Facility
|
IP
|
$3,503.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.20 |
| Max. Negotiated Rate |
$3,327.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,802.40
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$2,977.55
|
| Rate for Payer: First Health Commercial |
$3,152.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,152.70
|
| Rate for Payer: GEHA Commercial |
$2,452.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,152.70
|
| Rate for Payer: Multiplan All |
$3,187.73
|
| Rate for Payer: OMNI Networks Commercial |
$2,452.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,152.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,327.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,627.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,257.79
|
| Rate for Payer: Zelis Auto |
$1,401.20
|
|
|
IMPLT PLATE HUMERUS PLATE LATERAL
|
Facility
|
IP
|
$6,803.46
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,721.38 |
| Max. Negotiated Rate |
$6,463.29 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,442.77
|
| Rate for Payer: Cash Price |
$4,082.08
|
| Rate for Payer: Cash Price |
$4,082.08
|
| Rate for Payer: Cigna Commercial |
$5,782.94
|
| Rate for Payer: First Health Commercial |
$6,123.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,123.11
|
| Rate for Payer: GEHA Commercial |
$4,762.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,123.11
|
| Rate for Payer: Multiplan All |
$6,191.15
|
| Rate for Payer: OMNI Networks Commercial |
$4,762.42
|
| Rate for Payer: One Health Plan PPO/POS |
$6,123.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,463.29
|
| Rate for Payer: Three Rivers Provider Network All |
$5,102.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,327.22
|
| Rate for Payer: Zelis Auto |
$2,721.38
|
|
|
IMPLT PLATE HUMERUS PLATE LATERAL
|
Facility
|
OP
|
$6,803.46
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,700.87 |
| Max. Negotiated Rate |
$6,463.29 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,082.08
|
| Rate for Payer: Cash Price |
$4,082.08
|
| Rate for Payer: Cash Price |
$4,082.08
|
| Rate for Payer: Cigna Commercial |
$5,782.94
|
| Rate for Payer: First Health Commercial |
$6,123.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,123.11
|
| Rate for Payer: GEHA Commercial |
$5,442.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,123.11
|
| Rate for Payer: Humana ChoiceCare |
$1,768.90
|
| Rate for Payer: Multiplan All |
$6,191.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,082.08
|
| Rate for Payer: OMNI Networks Commercial |
$4,762.42
|
| Rate for Payer: One Health Plan PPO/POS |
$6,123.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,463.29
|
| Rate for Payer: Three Rivers Provider Network All |
$5,102.60
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,987.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,700.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,327.22
|
| Rate for Payer: Zelis Auto |
$2,721.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,401.73
|
|
|
IMPLT PLATE HUMERUS PROX 12-HOLE
|
Facility
|
IP
|
$6,653.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,661.20 |
| Max. Negotiated Rate |
$6,320.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,322.40
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$5,655.05
|
| Rate for Payer: First Health Commercial |
$5,987.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,987.70
|
| Rate for Payer: GEHA Commercial |
$4,657.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,987.70
|
| Rate for Payer: Multiplan All |
$6,054.23
|
| Rate for Payer: OMNI Networks Commercial |
$4,657.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,987.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,320.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,989.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,187.29
|
| Rate for Payer: Zelis Auto |
$2,661.20
|
|
