|
IMPLT PLATE LOCKING 1.7MM
|
Facility
|
OP
|
$1,207.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.75 |
| Max. Negotiated Rate |
$1,146.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.20
|
| 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 |
$965.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,086.30
|
| Rate for Payer: Humana ChoiceCare |
$313.82
|
| Rate for Payer: Multiplan All |
$1,098.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$724.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,062.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,122.51
|
| Rate for Payer: Zelis Auto |
$482.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$603.50
|
|
|
IMPLT PLATE LOCKING 3 HOLE 3.5X 89MM
|
Facility
|
OP
|
$5,737.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.25 |
| Max. Negotiated Rate |
$5,450.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,442.20
|
| Rate for Payer: Cash Price |
$3,442.20
|
| Rate for Payer: Cash Price |
$3,442.20
|
| Rate for Payer: Cigna Commercial |
$4,876.45
|
| Rate for Payer: First Health Commercial |
$5,163.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,163.30
|
| Rate for Payer: GEHA Commercial |
$4,589.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,163.30
|
| Rate for Payer: Humana ChoiceCare |
$1,491.62
|
| Rate for Payer: Multiplan All |
$5,220.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,442.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,015.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,163.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,450.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,302.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,048.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,434.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,335.41
|
| Rate for Payer: Zelis Auto |
$2,294.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,868.50
|
|
|
IMPLT PLATE LOCKING 3 HOLE 3.5X 89MM
|
Facility
|
IP
|
$5,737.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.80 |
| Max. Negotiated Rate |
$5,450.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,589.60
|
| Rate for Payer: Cash Price |
$3,442.20
|
| Rate for Payer: Cash Price |
$3,442.20
|
| Rate for Payer: Cigna Commercial |
$4,876.45
|
| Rate for Payer: First Health Commercial |
$5,163.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,163.30
|
| Rate for Payer: GEHA Commercial |
$4,015.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,163.30
|
| Rate for Payer: Multiplan All |
$5,220.67
|
| Rate for Payer: OMNI Networks Commercial |
$4,015.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,163.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,450.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,302.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,335.41
|
| Rate for Payer: Zelis Auto |
$2,294.80
|
|
|
IMPLT PLATE LOCKING 4-HOLE 3.5MMX73
|
Facility
|
IP
|
$6,509.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,603.60 |
| Max. Negotiated Rate |
$6,183.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,207.20
|
| Rate for Payer: Cash Price |
$3,905.40
|
| Rate for Payer: Cash Price |
$3,905.40
|
| Rate for Payer: Cigna Commercial |
$5,532.65
|
| Rate for Payer: First Health Commercial |
$5,858.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,858.10
|
| Rate for Payer: GEHA Commercial |
$4,556.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,858.10
|
| Rate for Payer: Multiplan All |
$5,923.19
|
| Rate for Payer: OMNI Networks Commercial |
$4,556.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,858.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,183.55
|
| Rate for Payer: Three Rivers Provider Network All |
$4,881.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,053.37
|
| Rate for Payer: Zelis Auto |
$2,603.60
|
|
|
IMPLT PLATE LOCKING 4-HOLE 3.5MMX73
|
Facility
|
OP
|
$6,509.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,627.25 |
| Max. Negotiated Rate |
$6,183.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,905.40
|
| Rate for Payer: Cash Price |
$3,905.40
|
| Rate for Payer: Cash Price |
$3,905.40
|
| Rate for Payer: Cigna Commercial |
$5,532.65
|
| Rate for Payer: First Health Commercial |
$5,858.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,858.10
|
| Rate for Payer: GEHA Commercial |
$5,207.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,858.10
|
| Rate for Payer: Humana ChoiceCare |
$1,692.34
|
| Rate for Payer: Multiplan All |
$5,923.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,905.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,556.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,858.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,183.55
|
| Rate for Payer: Three Rivers Provider Network All |
$4,881.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,727.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,627.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,053.37
|
| Rate for Payer: Zelis Auto |
$2,603.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,254.50
|
|
|
IMPLT PLATE LOCKING 5HOLE LEFT 62MM
|
Facility
|
OP
|
$2,249.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.25 |
| Max. Negotiated Rate |
$2,136.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,349.40
|
| Rate for Payer: Cash Price |
$1,349.40
|
| Rate for Payer: Cash Price |
$1,349.40
|
| Rate for Payer: Cigna Commercial |
$1,911.65
|
| Rate for Payer: First Health Commercial |
$2,024.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,024.10
|
| Rate for Payer: GEHA Commercial |
$1,799.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,024.10
|
| Rate for Payer: Humana ChoiceCare |
$584.74
|
| Rate for Payer: Multiplan All |
$2,046.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,349.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,574.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,024.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,136.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,686.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,979.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$562.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,091.57
|
| Rate for Payer: Zelis Auto |
$899.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,124.50
|
|
|
IMPLT PLATE LOCKING 5HOLE LEFT 62MM
|
Facility
|
IP
|
$2,249.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$899.60 |
| Max. Negotiated Rate |
$2,136.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,799.20
|
| Rate for Payer: Cash Price |
$1,349.40
|
| Rate for Payer: Cash Price |
$1,349.40
|
| Rate for Payer: Cigna Commercial |
$1,911.65
|
| Rate for Payer: First Health Commercial |
$2,024.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,024.10
|
| Rate for Payer: GEHA Commercial |
$1,574.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,024.10
|
| Rate for Payer: Multiplan All |
$2,046.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,574.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,024.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,136.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,686.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,091.57
|
| Rate for Payer: Zelis Auto |
$899.60
|
|
|
IMPLT PLATE LOCKING BAR STRAIGHT 4HOLE
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.75 |
| Max. Negotiated Rate |
$1,591.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,423.75
|
| Rate for Payer: First Health Commercial |
$1,507.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,507.50
|
| Rate for Payer: GEHA Commercial |
$1,340.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,507.50
|
| Rate for Payer: Humana ChoiceCare |
$435.50
|
| Rate for Payer: Multiplan All |
$1,524.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,005.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,172.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,507.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,591.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,256.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,474.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$418.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,557.75
|
| Rate for Payer: Zelis Auto |
$670.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$837.50
|
|
|
IMPLT PLATE LOCKING BAR STRAIGHT 4HOLE
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.00 |
| Max. Negotiated Rate |
$1,591.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,340.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,423.75
|
| Rate for Payer: First Health Commercial |
$1,507.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,507.50
|
| Rate for Payer: GEHA Commercial |
$1,172.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,507.50
|
| Rate for Payer: Multiplan All |
$1,524.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,172.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,507.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,591.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,256.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,557.75
|
| Rate for Payer: Zelis Auto |
$670.00
|
|
|
IMPLT PLATE LOCKING HOLE 6
|
Facility
|
OP
|
$4,692.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.00 |
| Max. Negotiated Rate |
$4,457.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,815.20
|
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Cigna Commercial |
$3,988.20
|
| Rate for Payer: First Health Commercial |
$4,222.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,222.80
|
| Rate for Payer: GEHA Commercial |
$3,753.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,222.80
|
| Rate for Payer: Humana ChoiceCare |
$1,219.92
|
| Rate for Payer: Multiplan All |
$4,269.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,815.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,284.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,222.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,457.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,519.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,128.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,173.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,363.56
|
| Rate for Payer: Zelis Auto |
$1,876.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,346.00
|
|
|
IMPLT PLATE LOCKING HOLE 6
|
Facility
|
IP
|
$4,692.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,876.80 |
| Max. Negotiated Rate |
$4,457.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,753.60
|
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Cigna Commercial |
$3,988.20
|
| Rate for Payer: First Health Commercial |
$4,222.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,222.80
|
| Rate for Payer: GEHA Commercial |
$3,284.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,222.80
|
| Rate for Payer: Multiplan All |
$4,269.72
|
| Rate for Payer: OMNI Networks Commercial |
$3,284.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,222.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,457.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,519.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,363.56
|
| Rate for Payer: Zelis Auto |
$1,876.80
|
|
|
IMPLT PLATE LOCKING HOLE 6 ELBOW
|
Facility
|
OP
|
$3,493.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000336
|
|
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 LOCKING HOLE 6 ELBOW
|
Facility
|
IP
|
$3,493.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000336
|
|
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 LOCKING LATERAL HOLE 3
|
Facility
|
OP
|
$3,806.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$951.50 |
| Max. Negotiated Rate |
$3,615.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cigna Commercial |
$3,235.10
|
| Rate for Payer: First Health Commercial |
$3,425.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,425.40
|
| Rate for Payer: GEHA Commercial |
$3,044.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,425.40
|
| Rate for Payer: Humana ChoiceCare |
$989.56
|
| Rate for Payer: Multiplan All |
$3,463.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,283.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,664.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,425.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,615.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,854.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,349.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$951.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,539.58
|
| Rate for Payer: Zelis Auto |
$1,522.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,903.00
|
|
|
IMPLT PLATE LOCKING LATERAL HOLE 3
|
Facility
|
IP
|
$3,806.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,522.40 |
| Max. Negotiated Rate |
$3,615.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,044.80
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cigna Commercial |
$3,235.10
|
| Rate for Payer: First Health Commercial |
$3,425.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,425.40
|
| Rate for Payer: GEHA Commercial |
$2,664.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,425.40
|
| Rate for Payer: Multiplan All |
$3,463.46
|
| Rate for Payer: OMNI Networks Commercial |
$2,664.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,425.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,615.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,854.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,539.58
|
| Rate for Payer: Zelis Auto |
$1,522.40
|
|
|
IMPLT PLATE LOCKING LAT. PROX 3.5MM
|
Facility
|
OP
|
$6,640.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.00 |
| Max. Negotiated Rate |
$6,308.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,984.00
|
| Rate for Payer: Cash Price |
$3,984.00
|
| Rate for Payer: Cash Price |
$3,984.00
|
| Rate for Payer: Cigna Commercial |
$5,644.00
|
| Rate for Payer: First Health Commercial |
$5,976.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,976.00
|
| Rate for Payer: GEHA Commercial |
$5,312.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,976.00
|
| Rate for Payer: Humana ChoiceCare |
$1,726.40
|
| Rate for Payer: Multiplan All |
$6,042.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,984.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,648.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,976.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,308.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,980.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,843.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,660.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,175.20
|
| Rate for Payer: Zelis Auto |
$2,656.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,320.00
|
|
|
IMPLT PLATE LOCKING LAT. PROX 3.5MM
|
Facility
|
IP
|
$6,640.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,656.00 |
| Max. Negotiated Rate |
$6,308.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,312.00
|
| Rate for Payer: Cash Price |
$3,984.00
|
| Rate for Payer: Cash Price |
$3,984.00
|
| Rate for Payer: Cigna Commercial |
$5,644.00
|
| Rate for Payer: First Health Commercial |
$5,976.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,976.00
|
| Rate for Payer: GEHA Commercial |
$4,648.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,976.00
|
| Rate for Payer: Multiplan All |
$6,042.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,648.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,976.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,308.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,980.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,175.20
|
| Rate for Payer: Zelis Auto |
$2,656.00
|
|
|
IMPLT PLATE LOCKING OLECRANON 107MM
|
Facility
|
IP
|
$4,075.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,630.00 |
| Max. Negotiated Rate |
$3,871.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,260.00
|
| Rate for Payer: Cash Price |
$2,445.00
|
| Rate for Payer: Cash Price |
$2,445.00
|
| Rate for Payer: Cigna Commercial |
$3,463.75
|
| Rate for Payer: First Health Commercial |
$3,667.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,667.50
|
| Rate for Payer: GEHA Commercial |
$2,852.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,667.50
|
| Rate for Payer: Multiplan All |
$3,708.25
|
| Rate for Payer: OMNI Networks Commercial |
$2,852.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,667.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,871.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,056.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,789.75
|
| Rate for Payer: Zelis Auto |
$1,630.00
|
|
|
IMPLT PLATE LOCKING OLECRANON 107MM
|
Facility
|
OP
|
$4,075.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.75 |
| Max. Negotiated Rate |
$3,871.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,445.00
|
| Rate for Payer: Cash Price |
$2,445.00
|
| Rate for Payer: Cash Price |
$2,445.00
|
| Rate for Payer: Cigna Commercial |
$3,463.75
|
| Rate for Payer: First Health Commercial |
$3,667.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,667.50
|
| Rate for Payer: GEHA Commercial |
$3,260.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,667.50
|
| Rate for Payer: Humana ChoiceCare |
$1,059.50
|
| Rate for Payer: Multiplan All |
$3,708.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,445.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,852.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,667.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,871.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,056.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,586.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,018.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,789.75
|
| Rate for Payer: Zelis Auto |
$1,630.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,037.50
|
|
|
IMPLT PLATE LOCKING OLECRANON 6 HOLE
|
Facility
|
OP
|
$5,535.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.75 |
| Max. Negotiated Rate |
$5,258.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,321.00
|
| Rate for Payer: Cash Price |
$3,321.00
|
| Rate for Payer: Cash Price |
$3,321.00
|
| Rate for Payer: Cigna Commercial |
$4,704.75
|
| Rate for Payer: First Health Commercial |
$4,981.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,981.50
|
| Rate for Payer: GEHA Commercial |
$4,428.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,981.50
|
| Rate for Payer: Humana ChoiceCare |
$1,439.10
|
| Rate for Payer: Multiplan All |
$5,036.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,321.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,874.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,981.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,258.25
|
| Rate for Payer: Three Rivers Provider Network All |
$4,151.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,870.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,383.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,147.55
|
| Rate for Payer: Zelis Auto |
$2,214.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,767.50
|
|
|
IMPLT PLATE LOCKING OLECRANON 6 HOLE
|
Facility
|
IP
|
$5,535.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$5,258.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,428.00
|
| Rate for Payer: Cash Price |
$3,321.00
|
| Rate for Payer: Cash Price |
$3,321.00
|
| Rate for Payer: Cigna Commercial |
$4,704.75
|
| Rate for Payer: First Health Commercial |
$4,981.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,981.50
|
| Rate for Payer: GEHA Commercial |
$3,874.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,981.50
|
| Rate for Payer: Multiplan All |
$5,036.85
|
| Rate for Payer: OMNI Networks Commercial |
$3,874.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,981.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,258.25
|
| Rate for Payer: Three Rivers Provider Network All |
$4,151.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,147.55
|
| Rate for Payer: Zelis Auto |
$2,214.00
|
|
|
IMPLT PLATE LOCKING PROX FEMUR 9H 234MM
|
Facility
|
OP
|
$3,995.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.75 |
| Max. Negotiated Rate |
$3,795.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,397.00
|
| Rate for Payer: Cash Price |
$2,397.00
|
| Rate for Payer: Cash Price |
$2,397.00
|
| Rate for Payer: Cigna Commercial |
$3,395.75
|
| Rate for Payer: First Health Commercial |
$3,595.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,595.50
|
| Rate for Payer: GEHA Commercial |
$3,196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,595.50
|
| Rate for Payer: Humana ChoiceCare |
$1,038.70
|
| Rate for Payer: Multiplan All |
$3,635.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,397.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,796.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,595.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,795.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,996.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,515.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$998.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,715.35
|
| Rate for Payer: Zelis Auto |
$1,598.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,997.50
|
|
|
IMPLT PLATE LOCKING PROX FEMUR 9H 234MM
|
Facility
|
IP
|
$3,995.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,598.00 |
| Max. Negotiated Rate |
$3,795.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,196.00
|
| Rate for Payer: Cash Price |
$2,397.00
|
| Rate for Payer: Cash Price |
$2,397.00
|
| Rate for Payer: Cigna Commercial |
$3,395.75
|
| Rate for Payer: First Health Commercial |
$3,595.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,595.50
|
| Rate for Payer: GEHA Commercial |
$2,796.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,595.50
|
| Rate for Payer: Multiplan All |
$3,635.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,796.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,595.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,795.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,996.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,715.35
|
| Rate for Payer: Zelis Auto |
$1,598.00
|
|
|
IMPLT PLATE LOCKING PROXIMAL FEMUR
|
Facility
|
OP
|
$9,169.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,292.25 |
| Max. Negotiated Rate |
$8,710.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,501.40
|
| Rate for Payer: Cash Price |
$5,501.40
|
| Rate for Payer: Cash Price |
$5,501.40
|
| Rate for Payer: Cigna Commercial |
$7,793.65
|
| Rate for Payer: First Health Commercial |
$8,252.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,252.10
|
| Rate for Payer: GEHA Commercial |
$7,335.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,252.10
|
| Rate for Payer: Humana ChoiceCare |
$2,383.94
|
| Rate for Payer: Multiplan All |
$8,343.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,501.40
|
| Rate for Payer: OMNI Networks Commercial |
$6,418.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8,252.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,710.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6,876.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,068.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,292.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,527.17
|
| Rate for Payer: Zelis Auto |
$3,667.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,584.50
|
|
|
IMPLT PLATE LOCKING PROXIMAL FEMUR
|
Facility
|
IP
|
$9,169.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,667.60 |
| Max. Negotiated Rate |
$8,710.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,335.20
|
| Rate for Payer: Cash Price |
$5,501.40
|
| Rate for Payer: Cash Price |
$5,501.40
|
| Rate for Payer: Cigna Commercial |
$7,793.65
|
| Rate for Payer: First Health Commercial |
$8,252.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,252.10
|
| Rate for Payer: GEHA Commercial |
$6,418.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,252.10
|
| Rate for Payer: Multiplan All |
$8,343.79
|
| Rate for Payer: OMNI Networks Commercial |
$6,418.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8,252.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,710.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6,876.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,527.17
|
| Rate for Payer: Zelis Auto |
$3,667.60
|
|
