|
IMPLT PLATE MED STANDARD 4 HOLE
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.75 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$716.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Humana ChoiceCare |
$232.70
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$537.00
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$787.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$447.50
|
|
|
IMPLT PLATE MINI FRAG STANDARD .55MM
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.50 |
| Max. Negotiated Rate |
$1,993.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,258.80
|
| Rate for Payer: Cash Price |
$1,258.80
|
| Rate for Payer: Cash Price |
$1,258.80
|
| Rate for Payer: Cigna Commercial |
$1,783.30
|
| Rate for Payer: First Health Commercial |
$1,888.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,888.20
|
| Rate for Payer: GEHA Commercial |
$1,678.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,888.20
|
| Rate for Payer: Humana ChoiceCare |
$545.48
|
| Rate for Payer: Multiplan All |
$1,909.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,258.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,468.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,888.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,993.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,573.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,846.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$524.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,951.14
|
| Rate for Payer: Zelis Auto |
$839.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,049.00
|
|
|
IMPLT PLATE MINI FRAG STANDARD .55MM
|
Facility
|
IP
|
$2,098.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$839.20 |
| Max. Negotiated Rate |
$1,993.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,678.40
|
| Rate for Payer: Cash Price |
$1,258.80
|
| Rate for Payer: Cash Price |
$1,258.80
|
| Rate for Payer: Cigna Commercial |
$1,783.30
|
| Rate for Payer: First Health Commercial |
$1,888.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,888.20
|
| Rate for Payer: GEHA Commercial |
$1,468.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,888.20
|
| Rate for Payer: Multiplan All |
$1,909.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,468.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,888.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,993.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,573.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,951.14
|
| Rate for Payer: Zelis Auto |
$839.20
|
|
|
IMPLT PLATE NARROW 13 HOLE
|
Facility
|
OP
|
$1,977.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.25 |
| Max. Negotiated Rate |
$1,878.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,186.20
|
| Rate for Payer: Cash Price |
$1,186.20
|
| Rate for Payer: Cash Price |
$1,186.20
|
| Rate for Payer: Cigna Commercial |
$1,680.45
|
| Rate for Payer: First Health Commercial |
$1,779.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,779.30
|
| Rate for Payer: GEHA Commercial |
$1,581.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,779.30
|
| Rate for Payer: Humana ChoiceCare |
$514.02
|
| Rate for Payer: Multiplan All |
$1,799.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,186.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,383.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,779.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,878.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,482.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,739.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$494.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,838.61
|
| Rate for Payer: Zelis Auto |
$790.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$988.50
|
|
|
IMPLT PLATE NARROW 13 HOLE
|
Facility
|
IP
|
$1,977.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.80 |
| Max. Negotiated Rate |
$1,878.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,581.60
|
| Rate for Payer: Cash Price |
$1,186.20
|
| Rate for Payer: Cash Price |
$1,186.20
|
| Rate for Payer: Cigna Commercial |
$1,680.45
|
| Rate for Payer: First Health Commercial |
$1,779.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,779.30
|
| Rate for Payer: GEHA Commercial |
$1,383.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,779.30
|
| Rate for Payer: Multiplan All |
$1,799.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,383.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,779.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,878.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,482.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,838.61
|
| Rate for Payer: Zelis Auto |
$790.80
|
|
|
IMPLT PLATE NARROW RIGHT
|
Facility
|
IP
|
$3,136.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,254.40 |
| Max. Negotiated Rate |
$2,979.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,508.80
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cigna Commercial |
$2,665.60
|
| Rate for Payer: First Health Commercial |
$2,822.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,822.40
|
| Rate for Payer: GEHA Commercial |
$2,195.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,822.40
|
| Rate for Payer: Multiplan All |
$2,853.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,195.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,822.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,979.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,352.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,916.48
|
| Rate for Payer: Zelis Auto |
$1,254.40
|
|
|
IMPLT PLATE NARROW RIGHT
|
Facility
|
OP
|
$3,136.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$784.00 |
| Max. Negotiated Rate |
$2,979.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,881.60
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cigna Commercial |
$2,665.60
|
| Rate for Payer: First Health Commercial |
$2,822.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,822.40
|
| Rate for Payer: GEHA Commercial |
$2,508.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,822.40
|
| Rate for Payer: Humana ChoiceCare |
$815.36
|
| Rate for Payer: Multiplan All |
$2,853.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,881.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,195.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,822.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,979.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,352.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,759.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$784.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,916.48
|
| Rate for Payer: Zelis Auto |
$1,254.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,568.00
|
|
|
IMPLT PLATE NARROW SHORT VARIAX
|
Facility
|
IP
|
$2,959.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.60 |
| Max. Negotiated Rate |
$2,811.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,367.20
|
| Rate for Payer: Cash Price |
$1,775.40
|
| Rate for Payer: Cash Price |
$1,775.40
|
| Rate for Payer: Cigna Commercial |
$2,515.15
|
| Rate for Payer: First Health Commercial |
$2,663.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,663.10
|
| Rate for Payer: GEHA Commercial |
$2,071.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,663.10
|
| Rate for Payer: Multiplan All |
$2,692.69
|
| Rate for Payer: OMNI Networks Commercial |
$2,071.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,663.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,811.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,219.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,751.87
|
| Rate for Payer: Zelis Auto |
$1,183.60
|
|
|
IMPLT PLATE NARROW SHORT VARIAX
|
Facility
|
OP
|
$2,959.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$739.75 |
| Max. Negotiated Rate |
$2,811.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,775.40
|
| Rate for Payer: Cash Price |
$1,775.40
|
| Rate for Payer: Cash Price |
$1,775.40
|
| Rate for Payer: Cigna Commercial |
$2,515.15
|
| Rate for Payer: First Health Commercial |
$2,663.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,663.10
|
| Rate for Payer: GEHA Commercial |
$2,367.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,663.10
|
| Rate for Payer: Humana ChoiceCare |
$769.34
|
| Rate for Payer: Multiplan All |
$2,692.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,775.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,071.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,663.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,811.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,219.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,603.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$739.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,751.87
|
| Rate for Payer: Zelis Auto |
$1,183.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,479.50
|
|
|
IMPLT PLATE NARROW STR 78MM 6 HL CMPR
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003353
|
|
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 NARROW STR 78MM 6 HL CMPR
|
Facility
|
OP
|
$1,776.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003353
|
|
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 NARROW TITANIUM VARIAX
|
Facility
|
IP
|
$2,820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.00 |
| Max. Negotiated Rate |
$2,679.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,256.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna Commercial |
$2,397.00
|
| Rate for Payer: First Health Commercial |
$2,538.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,538.00
|
| Rate for Payer: GEHA Commercial |
$1,974.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,538.00
|
| Rate for Payer: Multiplan All |
$2,566.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,974.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,538.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,679.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,115.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,622.60
|
| Rate for Payer: Zelis Auto |
$1,128.00
|
|
|
IMPLT PLATE NARROW TITANIUM VARIAX
|
Facility
|
OP
|
$2,820.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,679.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna Commercial |
$2,397.00
|
| Rate for Payer: First Health Commercial |
$2,538.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,538.00
|
| Rate for Payer: GEHA Commercial |
$2,256.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,538.00
|
| Rate for Payer: Humana ChoiceCare |
$733.20
|
| Rate for Payer: Multiplan All |
$2,566.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,692.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,974.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,538.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,679.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,115.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,481.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$705.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,622.60
|
| Rate for Payer: Zelis Auto |
$1,128.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,410.00
|
|
|
IMPLT PLATE NARROW VARIAX
|
Facility
|
IP
|
$2,753.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.20 |
| Max. Negotiated Rate |
$2,615.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,202.40
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cigna Commercial |
$2,340.05
|
| Rate for Payer: First Health Commercial |
$2,477.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,477.70
|
| Rate for Payer: GEHA Commercial |
$1,927.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,477.70
|
| Rate for Payer: Multiplan All |
$2,505.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,927.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,477.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,615.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,064.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,560.29
|
| Rate for Payer: Zelis Auto |
$1,101.20
|
|
|
IMPLT PLATE NARROW VARIAX
|
Facility
|
OP
|
$2,753.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$688.25 |
| Max. Negotiated Rate |
$2,615.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,651.80
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cigna Commercial |
$2,340.05
|
| Rate for Payer: First Health Commercial |
$2,477.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,477.70
|
| Rate for Payer: GEHA Commercial |
$2,202.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,477.70
|
| Rate for Payer: Humana ChoiceCare |
$715.78
|
| Rate for Payer: Multiplan All |
$2,505.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,651.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,927.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,477.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,615.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,064.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,422.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$688.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,560.29
|
| Rate for Payer: Zelis Auto |
$1,101.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,376.50
|
|
|
IMPLT PLATE NARROW VIRIAX
|
Facility
|
IP
|
$2,753.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.20 |
| Max. Negotiated Rate |
$2,615.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,202.40
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cigna Commercial |
$2,340.05
|
| Rate for Payer: First Health Commercial |
$2,477.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,477.70
|
| Rate for Payer: GEHA Commercial |
$1,927.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,477.70
|
| Rate for Payer: Multiplan All |
$2,505.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,927.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,477.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,615.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,064.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,560.29
|
| Rate for Payer: Zelis Auto |
$1,101.20
|
|
|
IMPLT PLATE NARROW VIRIAX
|
Facility
|
OP
|
$2,753.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$688.25 |
| Max. Negotiated Rate |
$2,615.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,651.80
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cash Price |
$1,651.80
|
| Rate for Payer: Cigna Commercial |
$2,340.05
|
| Rate for Payer: First Health Commercial |
$2,477.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,477.70
|
| Rate for Payer: GEHA Commercial |
$2,202.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,477.70
|
| Rate for Payer: Humana ChoiceCare |
$715.78
|
| Rate for Payer: Multiplan All |
$2,505.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,651.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,927.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,477.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,615.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,064.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,422.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$688.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,560.29
|
| Rate for Payer: Zelis Auto |
$1,101.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,376.50
|
|
|
IMPLT PLATE NEUTRAL WRIST FUSION
|
Facility
|
IP
|
$3,821.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.40 |
| Max. Negotiated Rate |
$3,629.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,056.80
|
| Rate for Payer: Cash Price |
$2,292.60
|
| Rate for Payer: Cash Price |
$2,292.60
|
| Rate for Payer: Cigna Commercial |
$3,247.85
|
| Rate for Payer: First Health Commercial |
$3,438.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,438.90
|
| Rate for Payer: GEHA Commercial |
$2,674.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,438.90
|
| Rate for Payer: Multiplan All |
$3,477.11
|
| Rate for Payer: OMNI Networks Commercial |
$2,674.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,438.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,629.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,865.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,553.53
|
| Rate for Payer: Zelis Auto |
$1,528.40
|
|
|
IMPLT PLATE NEUTRAL WRIST FUSION
|
Facility
|
OP
|
$3,821.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.25 |
| Max. Negotiated Rate |
$3,629.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,292.60
|
| Rate for Payer: Cash Price |
$2,292.60
|
| Rate for Payer: Cash Price |
$2,292.60
|
| Rate for Payer: Cigna Commercial |
$3,247.85
|
| Rate for Payer: First Health Commercial |
$3,438.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,438.90
|
| Rate for Payer: GEHA Commercial |
$3,056.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,438.90
|
| Rate for Payer: Humana ChoiceCare |
$993.46
|
| Rate for Payer: Multiplan All |
$3,477.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,292.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,674.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,438.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,629.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,865.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,362.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$955.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,553.53
|
| Rate for Payer: Zelis Auto |
$1,528.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,910.50
|
|
|
IMPLT PLATE OBLIQUE LEFT HOLE 7 34MM
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$465.80
|
| Rate for Payer: First Health Commercial |
$493.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.20
|
| Rate for Payer: GEHA Commercial |
$438.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.20
|
| Rate for Payer: Humana ChoiceCare |
$142.48
|
| Rate for Payer: Multiplan All |
$498.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$328.80
|
| Rate for Payer: OMNI Networks Commercial |
$383.60
|
| Rate for Payer: One Health Plan PPO/POS |
$493.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$520.60
|
| Rate for Payer: Three Rivers Provider Network All |
$411.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$482.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$509.64
|
| Rate for Payer: Zelis Auto |
$219.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$274.00
|
|
|
IMPLT PLATE OBLIQUE LEFT HOLE 7 34MM
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$438.40
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$465.80
|
| Rate for Payer: First Health Commercial |
$493.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.20
|
| Rate for Payer: GEHA Commercial |
$383.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.20
|
| Rate for Payer: Multiplan All |
$498.68
|
| Rate for Payer: OMNI Networks Commercial |
$383.60
|
| Rate for Payer: One Health Plan PPO/POS |
$493.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$520.60
|
| Rate for Payer: Three Rivers Provider Network All |
$411.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$509.64
|
| Rate for Payer: Zelis Auto |
$219.20
|
|
|
IMPLT PLATE OLECRANON
|
Facility
|
IP
|
$5,554.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,221.60 |
| Max. Negotiated Rate |
$5,276.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,443.20
|
| Rate for Payer: Cash Price |
$3,332.40
|
| Rate for Payer: Cash Price |
$3,332.40
|
| Rate for Payer: Cigna Commercial |
$4,720.90
|
| Rate for Payer: First Health Commercial |
$4,998.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,998.60
|
| Rate for Payer: GEHA Commercial |
$3,887.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,998.60
|
| Rate for Payer: Multiplan All |
$5,054.14
|
| Rate for Payer: OMNI Networks Commercial |
$3,887.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,998.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,276.30
|
| Rate for Payer: Three Rivers Provider Network All |
$4,165.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,165.22
|
| Rate for Payer: Zelis Auto |
$2,221.60
|
|
|
IMPLT PLATE OLECRANON
|
Facility
|
OP
|
$5,554.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.50 |
| Max. Negotiated Rate |
$5,276.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,332.40
|
| Rate for Payer: Cash Price |
$3,332.40
|
| Rate for Payer: Cash Price |
$3,332.40
|
| Rate for Payer: Cigna Commercial |
$4,720.90
|
| Rate for Payer: First Health Commercial |
$4,998.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,998.60
|
| Rate for Payer: GEHA Commercial |
$4,443.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,998.60
|
| Rate for Payer: Humana ChoiceCare |
$1,444.04
|
| Rate for Payer: Multiplan All |
$5,054.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,332.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,887.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,998.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,276.30
|
| Rate for Payer: Three Rivers Provider Network All |
$4,165.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,887.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,388.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,165.22
|
| Rate for Payer: Zelis Auto |
$2,221.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,777.00
|
|
|
IMPLT PLATE OLECRANON 6HOLE RIGHT
|
Facility
|
OP
|
$5,535.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001205
|
|
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 OLECRANON 6HOLE RIGHT
|
Facility
|
IP
|
$5,535.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001205
|
|
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
|
|
