|
IMPLT PLATE LCP 6 HOLE 85MM
|
Facility
|
OP
|
$2,036.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.00 |
| Max. Negotiated Rate |
$1,934.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,221.60
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Cigna Commercial |
$1,730.60
|
| Rate for Payer: First Health Commercial |
$1,832.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,832.40
|
| Rate for Payer: GEHA Commercial |
$1,628.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,832.40
|
| Rate for Payer: Humana ChoiceCare |
$529.36
|
| Rate for Payer: Multiplan All |
$1,852.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,221.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,425.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,832.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,934.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,527.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,791.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$509.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,893.48
|
| Rate for Payer: Zelis Auto |
$814.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,018.00
|
|
|
IMPLT PLATE LCP 6 HOLE 85MM
|
Facility
|
IP
|
$2,036.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$814.40 |
| Max. Negotiated Rate |
$1,934.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,628.80
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Cigna Commercial |
$1,730.60
|
| Rate for Payer: First Health Commercial |
$1,832.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,832.40
|
| Rate for Payer: GEHA Commercial |
$1,425.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,832.40
|
| Rate for Payer: Multiplan All |
$1,852.76
|
| Rate for Payer: OMNI Networks Commercial |
$1,425.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,832.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,934.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,527.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,893.48
|
| Rate for Payer: Zelis Auto |
$814.40
|
|
|
IMPLT PLATE,LCP,8 HOLE,111MM
|
Facility
|
IP
|
$2,247.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.80 |
| Max. Negotiated Rate |
$2,134.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,797.60
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cigna Commercial |
$1,909.95
|
| Rate for Payer: First Health Commercial |
$2,022.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,022.30
|
| Rate for Payer: GEHA Commercial |
$1,572.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,022.30
|
| Rate for Payer: Multiplan All |
$2,044.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,572.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,022.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,134.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,685.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,089.71
|
| Rate for Payer: Zelis Auto |
$898.80
|
|
|
IMPLT PLATE,LCP,8 HOLE,111MM
|
Facility
|
OP
|
$2,247.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.75 |
| Max. Negotiated Rate |
$2,134.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,348.20
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cigna Commercial |
$1,909.95
|
| Rate for Payer: First Health Commercial |
$2,022.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,022.30
|
| Rate for Payer: GEHA Commercial |
$1,797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,022.30
|
| Rate for Payer: Humana ChoiceCare |
$584.22
|
| Rate for Payer: Multiplan All |
$2,044.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,348.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,572.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,022.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,134.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,685.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,977.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$561.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,089.71
|
| Rate for Payer: Zelis Auto |
$898.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,123.50
|
|
|
IMPLT PLATE LCP 9 HOLE 3.5MM
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.20 |
| Max. Negotiated Rate |
$1,028.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$866.40
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cigna Commercial |
$920.55
|
| Rate for Payer: First Health Commercial |
$974.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$974.70
|
| Rate for Payer: GEHA Commercial |
$758.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$974.70
|
| Rate for Payer: Multiplan All |
$985.53
|
| Rate for Payer: OMNI Networks Commercial |
$758.10
|
| Rate for Payer: One Health Plan PPO/POS |
$974.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,028.85
|
| Rate for Payer: Three Rivers Provider Network All |
$812.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,007.19
|
| Rate for Payer: Zelis Auto |
$433.20
|
|
|
IMPLT PLATE LCP 9 HOLE 3.5MM
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.75 |
| Max. Negotiated Rate |
$1,028.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cigna Commercial |
$920.55
|
| Rate for Payer: First Health Commercial |
$974.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$974.70
|
| Rate for Payer: GEHA Commercial |
$866.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$974.70
|
| Rate for Payer: Humana ChoiceCare |
$281.58
|
| Rate for Payer: Multiplan All |
$985.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$649.80
|
| Rate for Payer: OMNI Networks Commercial |
$758.10
|
| Rate for Payer: One Health Plan PPO/POS |
$974.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,028.85
|
| Rate for Payer: Three Rivers Provider Network All |
$812.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$953.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$270.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,007.19
|
| Rate for Payer: Zelis Auto |
$433.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$541.50
|
|
|
IMPLT PLATE LCP TUBULAR 5 HOLE 57MM
|
Facility
|
OP
|
$1,067.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.75 |
| Max. Negotiated Rate |
$1,013.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cigna Commercial |
$906.95
|
| Rate for Payer: First Health Commercial |
$960.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$960.30
|
| Rate for Payer: GEHA Commercial |
$853.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$960.30
|
| Rate for Payer: Humana ChoiceCare |
$277.42
|
| Rate for Payer: Multiplan All |
$970.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$640.20
|
| Rate for Payer: OMNI Networks Commercial |
$746.90
|
| Rate for Payer: One Health Plan PPO/POS |
$960.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,013.65
|
| Rate for Payer: Three Rivers Provider Network All |
$800.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$938.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$992.31
|
| Rate for Payer: Zelis Auto |
$426.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$533.50
|
|
|
IMPLT PLATE LCP TUBULAR 5 HOLE 57MM
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.80 |
| Max. Negotiated Rate |
$1,013.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$853.60
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cigna Commercial |
$906.95
|
| Rate for Payer: First Health Commercial |
$960.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$960.30
|
| Rate for Payer: GEHA Commercial |
$746.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$960.30
|
| Rate for Payer: Multiplan All |
$970.97
|
| Rate for Payer: OMNI Networks Commercial |
$746.90
|
| Rate for Payer: One Health Plan PPO/POS |
$960.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,013.65
|
| Rate for Payer: Three Rivers Provider Network All |
$800.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$992.31
|
| Rate for Payer: Zelis Auto |
$426.80
|
|
|
IMPLT PLATE LEFT 4 HOLE
|
Facility
|
IP
|
$3,493.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,397.20 |
| Max. Negotiated Rate |
$3,318.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,794.40
|
| Rate for Payer: Cash Price |
$2,095.80
|
| Rate for Payer: Cash Price |
$2,095.80
|
| Rate for Payer: Cigna Commercial |
$2,969.05
|
| Rate for Payer: First Health Commercial |
$3,143.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,143.70
|
| Rate for Payer: GEHA Commercial |
$2,445.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,143.70
|
| Rate for Payer: Multiplan All |
$3,178.63
|
| Rate for Payer: OMNI Networks Commercial |
$2,445.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,143.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,318.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,619.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,248.49
|
| Rate for Payer: Zelis Auto |
$1,397.20
|
|
|
IMPLT PLATE LEFT 4 HOLE
|
Facility
|
OP
|
$3,493.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$873.25 |
| Max. Negotiated Rate |
$3,318.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,095.80
|
| Rate for Payer: Cash Price |
$2,095.80
|
| Rate for Payer: Cash Price |
$2,095.80
|
| Rate for Payer: Cigna Commercial |
$2,969.05
|
| Rate for Payer: First Health Commercial |
$3,143.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,143.70
|
| Rate for Payer: GEHA Commercial |
$2,794.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,143.70
|
| Rate for Payer: Humana ChoiceCare |
$908.18
|
| Rate for Payer: Multiplan All |
$3,178.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,095.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,445.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,143.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,318.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,619.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,073.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$873.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,248.49
|
| Rate for Payer: Zelis Auto |
$1,397.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,746.50
|
|
|
IMPLT PLATE LEFT 7HOLE 56MM
|
Facility
|
OP
|
$2,899.89
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.97 |
| Max. Negotiated Rate |
$2,754.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,739.93
|
| Rate for Payer: Cash Price |
$1,739.93
|
| Rate for Payer: Cash Price |
$1,739.93
|
| Rate for Payer: Cigna Commercial |
$2,464.91
|
| Rate for Payer: First Health Commercial |
$2,609.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,609.90
|
| Rate for Payer: GEHA Commercial |
$2,319.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,609.90
|
| Rate for Payer: Humana ChoiceCare |
$753.97
|
| Rate for Payer: Multiplan All |
$2,638.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,739.93
|
| Rate for Payer: OMNI Networks Commercial |
$2,029.92
|
| Rate for Payer: One Health Plan PPO/POS |
$2,609.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,754.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,174.92
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$724.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,696.90
|
| Rate for Payer: Zelis Auto |
$1,159.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,449.94
|
|
|
IMPLT PLATE LEFT 7HOLE 56MM
|
Facility
|
IP
|
$2,899.89
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,159.96 |
| Max. Negotiated Rate |
$2,754.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,319.91
|
| Rate for Payer: Cash Price |
$1,739.93
|
| Rate for Payer: Cash Price |
$1,739.93
|
| Rate for Payer: Cigna Commercial |
$2,464.91
|
| Rate for Payer: First Health Commercial |
$2,609.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,609.90
|
| Rate for Payer: GEHA Commercial |
$2,029.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,609.90
|
| Rate for Payer: Multiplan All |
$2,638.90
|
| Rate for Payer: OMNI Networks Commercial |
$2,029.92
|
| Rate for Payer: One Health Plan PPO/POS |
$2,609.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,754.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,174.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,696.90
|
| Rate for Payer: Zelis Auto |
$1,159.96
|
|
|
IMPLT PLATE LENGTHENING 0MM
|
Facility
|
IP
|
$4,986.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,994.40 |
| Max. Negotiated Rate |
$4,736.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,988.80
|
| Rate for Payer: Cash Price |
$2,991.60
|
| Rate for Payer: Cash Price |
$2,991.60
|
| Rate for Payer: Cigna Commercial |
$4,238.10
|
| Rate for Payer: First Health Commercial |
$4,487.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,487.40
|
| Rate for Payer: GEHA Commercial |
$3,490.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,487.40
|
| Rate for Payer: Multiplan All |
$4,537.26
|
| Rate for Payer: OMNI Networks Commercial |
$3,490.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,487.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,736.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,739.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,636.98
|
| Rate for Payer: Zelis Auto |
$1,994.40
|
|
|
IMPLT PLATE LENGTHENING 0MM
|
Facility
|
OP
|
$4,986.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.50 |
| Max. Negotiated Rate |
$4,736.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,991.60
|
| Rate for Payer: Cash Price |
$2,991.60
|
| Rate for Payer: Cash Price |
$2,991.60
|
| Rate for Payer: Cigna Commercial |
$4,238.10
|
| Rate for Payer: First Health Commercial |
$4,487.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,487.40
|
| Rate for Payer: GEHA Commercial |
$3,988.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,487.40
|
| Rate for Payer: Humana ChoiceCare |
$1,296.36
|
| Rate for Payer: Multiplan All |
$4,537.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,991.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,490.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,487.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,736.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,739.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,387.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,246.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,636.98
|
| Rate for Payer: Zelis Auto |
$1,994.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,493.00
|
|
|
IMPLT PLATE L HOLE 6 RIGHT
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,047.20
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
|
|
IMPLT PLATE L HOLE 6 RIGHT
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Humana ChoiceCare |
$340.34
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$785.40
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,151.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$327.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$654.50
|
|
|
IMPLT PLATE L HOLE TWO 2.0MM
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.25 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$410.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| Rate for Payer: Humana ChoiceCare |
$133.38
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$307.80
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$451.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$128.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: Zelis Auto |
$205.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$256.50
|
|
|
IMPLT PLATE L HOLE TWO 2.0MM
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$410.40
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$359.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: Zelis Auto |
$205.20
|
|
|
IMPLT PLATE LNG 36XX 3.5MM SCR 6 HL LCK
|
Facility
|
IP
|
$4,149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.60 |
| Max. Negotiated Rate |
$3,941.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,319.20
|
| Rate for Payer: Cash Price |
$2,489.40
|
| Rate for Payer: Cash Price |
$2,489.40
|
| Rate for Payer: Cigna Commercial |
$3,526.65
|
| Rate for Payer: First Health Commercial |
$3,734.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,734.10
|
| Rate for Payer: GEHA Commercial |
$2,904.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,734.10
|
| Rate for Payer: Multiplan All |
$3,775.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,904.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,734.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,941.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,111.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,858.57
|
| Rate for Payer: Zelis Auto |
$1,659.60
|
|
|
IMPLT PLATE LNG 36XX 3.5MM SCR 6 HL LCK
|
Facility
|
OP
|
$4,149.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.25 |
| Max. Negotiated Rate |
$3,941.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,489.40
|
| Rate for Payer: Cash Price |
$2,489.40
|
| Rate for Payer: Cash Price |
$2,489.40
|
| Rate for Payer: Cigna Commercial |
$3,526.65
|
| Rate for Payer: First Health Commercial |
$3,734.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,734.10
|
| Rate for Payer: GEHA Commercial |
$3,319.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,734.10
|
| Rate for Payer: Humana ChoiceCare |
$1,078.74
|
| Rate for Payer: Multiplan All |
$3,775.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,489.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,904.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,734.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,941.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,111.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,651.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,037.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,858.57
|
| Rate for Payer: Zelis Auto |
$1,659.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,074.50
|
|
|
IMPLT PLATE LOCKING 10 HOLE RIGHT
|
Facility
|
IP
|
$3,797.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001193
|
|
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 LOCKING 10 HOLE RIGHT
|
Facility
|
OP
|
$3,797.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001193
|
|
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 LOCKING 1.7
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.50 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,729.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$562.12
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,297.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,902.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$540.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,081.00
|
|
|
IMPLT PLATE LOCKING 1.7
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,513.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
|
|
IMPLT PLATE LOCKING 1.7MM
|
Facility
|
IP
|
$1,207.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.80 |
| Max. Negotiated Rate |
$1,146.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$965.60
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$1,025.95
|
| Rate for Payer: First Health Commercial |
$1,086.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,086.30
|
| Rate for Payer: GEHA Commercial |
$844.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,086.30
|
| Rate for Payer: Multiplan All |
$1,098.37
|
| Rate for Payer: OMNI Networks Commercial |
$844.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,086.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,146.65
|
| Rate for Payer: Three Rivers Provider Network All |
$905.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,122.51
|
| Rate for Payer: Zelis Auto |
$482.80
|
|
