|
IMPLT PLATE RADIUS DISTAL LEFT
|
Facility
|
IP
|
$3,505.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.00 |
| Max. Negotiated Rate |
$3,329.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,804.00
|
| Rate for Payer: Cash Price |
$2,103.00
|
| Rate for Payer: Cash Price |
$2,103.00
|
| Rate for Payer: Cigna Commercial |
$2,979.25
|
| Rate for Payer: First Health Commercial |
$3,154.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,154.50
|
| Rate for Payer: GEHA Commercial |
$2,453.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,154.50
|
| Rate for Payer: Multiplan All |
$3,189.55
|
| Rate for Payer: OMNI Networks Commercial |
$2,453.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,154.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,329.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,628.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,259.65
|
| Rate for Payer: Zelis Auto |
$1,402.00
|
|
|
IMPLT PLATE RECON 427038
|
Facility
|
OP
|
$2,626.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.50 |
| Max. Negotiated Rate |
$2,494.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,575.60
|
| Rate for Payer: Cash Price |
$1,575.60
|
| Rate for Payer: Cash Price |
$1,575.60
|
| Rate for Payer: Cigna Commercial |
$2,232.10
|
| Rate for Payer: First Health Commercial |
$2,363.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,363.40
|
| Rate for Payer: GEHA Commercial |
$2,100.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,363.40
|
| Rate for Payer: Humana ChoiceCare |
$682.76
|
| Rate for Payer: Multiplan All |
$2,389.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,575.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,838.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,363.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,494.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,969.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,310.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$656.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,442.18
|
| Rate for Payer: Zelis Auto |
$1,050.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,313.00
|
|
|
IMPLT PLATE RECON 427038
|
Facility
|
IP
|
$2,626.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.40 |
| Max. Negotiated Rate |
$2,494.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,100.80
|
| Rate for Payer: Cash Price |
$1,575.60
|
| Rate for Payer: Cash Price |
$1,575.60
|
| Rate for Payer: Cigna Commercial |
$2,232.10
|
| Rate for Payer: First Health Commercial |
$2,363.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,363.40
|
| Rate for Payer: GEHA Commercial |
$1,838.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,363.40
|
| Rate for Payer: Multiplan All |
$2,389.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,838.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,363.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,494.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,969.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,442.18
|
| Rate for Payer: Zelis Auto |
$1,050.40
|
|
|
IMPLT PLATE RECON 427040
|
Facility
|
OP
|
$2,626.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.50 |
| Max. Negotiated Rate |
$2,494.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,575.60
|
| Rate for Payer: Cash Price |
$1,575.60
|
| Rate for Payer: Cash Price |
$1,575.60
|
| Rate for Payer: Cigna Commercial |
$2,232.10
|
| Rate for Payer: First Health Commercial |
$2,363.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,363.40
|
| Rate for Payer: GEHA Commercial |
$2,100.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,363.40
|
| Rate for Payer: Humana ChoiceCare |
$682.76
|
| Rate for Payer: Multiplan All |
$2,389.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,575.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,838.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,363.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,494.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,969.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,310.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$656.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,442.18
|
| Rate for Payer: Zelis Auto |
$1,050.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,313.00
|
|
|
IMPLT PLATE RECON 427040
|
Facility
|
IP
|
$2,626.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.40 |
| Max. Negotiated Rate |
$2,494.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,100.80
|
| Rate for Payer: Cash Price |
$1,575.60
|
| Rate for Payer: Cash Price |
$1,575.60
|
| Rate for Payer: Cigna Commercial |
$2,232.10
|
| Rate for Payer: First Health Commercial |
$2,363.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,363.40
|
| Rate for Payer: GEHA Commercial |
$1,838.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,363.40
|
| Rate for Payer: Multiplan All |
$2,389.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,838.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,363.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,494.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,969.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,442.18
|
| Rate for Payer: Zelis Auto |
$1,050.40
|
|
|
IMPLT PLATE RIM STANDARD LONG R HEAD
|
Facility
|
IP
|
$3,370.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.00 |
| Max. Negotiated Rate |
$3,201.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,696.00
|
| Rate for Payer: Cash Price |
$2,022.00
|
| Rate for Payer: Cash Price |
$2,022.00
|
| Rate for Payer: Cigna Commercial |
$2,864.50
|
| Rate for Payer: First Health Commercial |
$3,033.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,033.00
|
| Rate for Payer: GEHA Commercial |
$2,359.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,033.00
|
| Rate for Payer: Multiplan All |
$3,066.70
|
| Rate for Payer: OMNI Networks Commercial |
$2,359.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,033.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,201.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,527.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,134.10
|
| Rate for Payer: Zelis Auto |
$1,348.00
|
|
|
IMPLT PLATE RIM STANDARD LONG R HEAD
|
Facility
|
IP
|
$3,370.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.00 |
| Max. Negotiated Rate |
$3,201.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,696.00
|
| Rate for Payer: Cash Price |
$2,022.00
|
| Rate for Payer: Cash Price |
$2,022.00
|
| Rate for Payer: Cigna Commercial |
$2,864.50
|
| Rate for Payer: First Health Commercial |
$3,033.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,033.00
|
| Rate for Payer: GEHA Commercial |
$2,359.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,033.00
|
| Rate for Payer: Multiplan All |
$3,066.70
|
| Rate for Payer: OMNI Networks Commercial |
$2,359.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,033.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,201.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,527.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,134.10
|
| Rate for Payer: Zelis Auto |
$1,348.00
|
|
|
IMPLT PLATE RIM STANDARD LONG R HEAD
|
Facility
|
OP
|
$3,370.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$842.50 |
| Max. Negotiated Rate |
$3,201.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,022.00
|
| Rate for Payer: Cash Price |
$2,022.00
|
| Rate for Payer: Cash Price |
$2,022.00
|
| Rate for Payer: Cigna Commercial |
$2,864.50
|
| Rate for Payer: First Health Commercial |
$3,033.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,033.00
|
| Rate for Payer: GEHA Commercial |
$2,696.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,033.00
|
| Rate for Payer: Humana ChoiceCare |
$876.20
|
| Rate for Payer: Multiplan All |
$3,066.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,022.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,359.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,033.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,201.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,527.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,965.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$842.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,134.10
|
| Rate for Payer: Zelis Auto |
$1,348.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,685.00
|
|
|
IMPLT PLATE RIM STANDARD LONG R HEAD
|
Facility
|
OP
|
$3,370.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$842.50 |
| Max. Negotiated Rate |
$3,201.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,022.00
|
| Rate for Payer: Cash Price |
$2,022.00
|
| Rate for Payer: Cash Price |
$2,022.00
|
| Rate for Payer: Cigna Commercial |
$2,864.50
|
| Rate for Payer: First Health Commercial |
$3,033.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,033.00
|
| Rate for Payer: GEHA Commercial |
$2,696.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,033.00
|
| Rate for Payer: Humana ChoiceCare |
$876.20
|
| Rate for Payer: Multiplan All |
$3,066.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,022.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,359.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,033.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,201.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,527.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,965.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$842.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,134.10
|
| Rate for Payer: Zelis Auto |
$1,348.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,685.00
|
|
|
IMPLT PLATE RIM STANDARD STD R HEAD
|
Facility
|
IP
|
$6,270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,508.00 |
| Max. Negotiated Rate |
$5,956.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,016.00
|
| Rate for Payer: Cash Price |
$3,762.00
|
| Rate for Payer: Cash Price |
$3,762.00
|
| Rate for Payer: Cigna Commercial |
$5,329.50
|
| Rate for Payer: First Health Commercial |
$5,643.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,643.00
|
| Rate for Payer: GEHA Commercial |
$4,389.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,643.00
|
| Rate for Payer: Multiplan All |
$5,705.70
|
| Rate for Payer: OMNI Networks Commercial |
$4,389.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,643.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,956.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,702.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,831.10
|
| Rate for Payer: Zelis Auto |
$2,508.00
|
|
|
IMPLT PLATE RIM STANDARD STD R HEAD
|
Facility
|
OP
|
$6,270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.50 |
| Max. Negotiated Rate |
$5,956.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,762.00
|
| Rate for Payer: Cash Price |
$3,762.00
|
| Rate for Payer: Cash Price |
$3,762.00
|
| Rate for Payer: Cigna Commercial |
$5,329.50
|
| Rate for Payer: First Health Commercial |
$5,643.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,643.00
|
| Rate for Payer: GEHA Commercial |
$5,016.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,643.00
|
| Rate for Payer: Humana ChoiceCare |
$1,630.20
|
| Rate for Payer: Multiplan All |
$5,705.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,762.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,389.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,643.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,956.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,702.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,517.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,567.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,831.10
|
| Rate for Payer: Zelis Auto |
$2,508.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,135.00
|
|
|
IMPLT PLATE RT CLAVICLE
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$3,564.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cigna Commercial |
$3,189.20
|
| Rate for Payer: First Health Commercial |
$3,376.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,376.80
|
| Rate for Payer: GEHA Commercial |
$3,001.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,376.80
|
| Rate for Payer: Humana ChoiceCare |
$975.52
|
| Rate for Payer: Multiplan All |
$3,414.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,251.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,626.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,376.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,564.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,814.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,301.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$938.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,489.36
|
| Rate for Payer: Zelis Auto |
$1,500.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,876.00
|
|
|
IMPLT PLATE RT CLAVICLE
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.80 |
| Max. Negotiated Rate |
$3,564.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,001.60
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cigna Commercial |
$3,189.20
|
| Rate for Payer: First Health Commercial |
$3,376.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,376.80
|
| Rate for Payer: GEHA Commercial |
$2,626.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,376.80
|
| Rate for Payer: Multiplan All |
$3,414.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,626.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,376.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,564.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,814.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,489.36
|
| Rate for Payer: Zelis Auto |
$1,500.80
|
|
|
IMPLT PLATE RT CLAVICLE
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.80 |
| Max. Negotiated Rate |
$3,564.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,001.60
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cigna Commercial |
$3,189.20
|
| Rate for Payer: First Health Commercial |
$3,376.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,376.80
|
| Rate for Payer: GEHA Commercial |
$2,626.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,376.80
|
| Rate for Payer: Multiplan All |
$3,414.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,626.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,376.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,564.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,814.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,489.36
|
| Rate for Payer: Zelis Auto |
$1,500.80
|
|
|
IMPLT PLATE RT CLAVICLE
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$3,564.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cigna Commercial |
$3,189.20
|
| Rate for Payer: First Health Commercial |
$3,376.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,376.80
|
| Rate for Payer: GEHA Commercial |
$3,001.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,376.80
|
| Rate for Payer: Humana ChoiceCare |
$975.52
|
| Rate for Payer: Multiplan All |
$3,414.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,251.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,626.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,376.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,564.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,814.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,301.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$938.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,489.36
|
| Rate for Payer: Zelis Auto |
$1,500.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,876.00
|
|
|
IMPLT PLATE SHAFT MID SUPER
|
Facility
|
IP
|
$3,718.68
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,487.47 |
| Max. Negotiated Rate |
$3,532.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,974.94
|
| Rate for Payer: Cash Price |
$2,231.21
|
| Rate for Payer: Cash Price |
$2,231.21
|
| Rate for Payer: Cigna Commercial |
$3,160.88
|
| Rate for Payer: First Health Commercial |
$3,346.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,346.81
|
| Rate for Payer: GEHA Commercial |
$2,603.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,346.81
|
| Rate for Payer: Multiplan All |
$3,384.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,603.08
|
| Rate for Payer: One Health Plan PPO/POS |
$3,346.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,532.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,789.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,458.37
|
| Rate for Payer: Zelis Auto |
$1,487.47
|
|
|
IMPLT PLATE SHAFT MID SUPER
|
Facility
|
OP
|
$3,718.68
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.67 |
| Max. Negotiated Rate |
$3,532.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,231.21
|
| Rate for Payer: Cash Price |
$2,231.21
|
| Rate for Payer: Cash Price |
$2,231.21
|
| Rate for Payer: Cigna Commercial |
$3,160.88
|
| Rate for Payer: First Health Commercial |
$3,346.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,346.81
|
| Rate for Payer: GEHA Commercial |
$2,974.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,346.81
|
| Rate for Payer: Humana ChoiceCare |
$966.86
|
| Rate for Payer: Multiplan All |
$3,384.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,231.21
|
| Rate for Payer: OMNI Networks Commercial |
$2,603.08
|
| Rate for Payer: One Health Plan PPO/POS |
$3,346.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,532.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,789.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,272.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$929.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,458.37
|
| Rate for Payer: Zelis Auto |
$1,487.47
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,859.34
|
|
|
IMPLT PLATE SHAFT MID SUPERIOR LEFT
|
Facility
|
IP
|
$3,279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.60 |
| Max. Negotiated Rate |
$3,115.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,623.20
|
| Rate for Payer: Cash Price |
$1,967.40
|
| Rate for Payer: Cash Price |
$1,967.40
|
| Rate for Payer: Cigna Commercial |
$2,787.15
|
| Rate for Payer: First Health Commercial |
$2,951.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,951.10
|
| Rate for Payer: GEHA Commercial |
$2,295.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,951.10
|
| Rate for Payer: Multiplan All |
$2,983.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,295.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,951.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,115.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,459.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,049.47
|
| Rate for Payer: Zelis Auto |
$1,311.60
|
|
|
IMPLT PLATE SHAFT MID SUPERIOR LEFT
|
Facility
|
OP
|
$3,279.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.75 |
| Max. Negotiated Rate |
$3,115.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,967.40
|
| Rate for Payer: Cash Price |
$1,967.40
|
| Rate for Payer: Cash Price |
$1,967.40
|
| Rate for Payer: Cigna Commercial |
$2,787.15
|
| Rate for Payer: First Health Commercial |
$2,951.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,951.10
|
| Rate for Payer: GEHA Commercial |
$2,623.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,951.10
|
| Rate for Payer: Humana ChoiceCare |
$852.54
|
| Rate for Payer: Multiplan All |
$2,983.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,967.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,295.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,951.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,115.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,459.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,885.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$819.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,049.47
|
| Rate for Payer: Zelis Auto |
$1,311.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,639.50
|
|
|
IMPLT PLATE SHAFT MID SUPER RT 99MM 6HL
|
Facility
|
IP
|
$4,048.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,619.20 |
| Max. Negotiated Rate |
$3,845.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,238.40
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cigna Commercial |
$3,440.80
|
| Rate for Payer: First Health Commercial |
$3,643.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,643.20
|
| Rate for Payer: GEHA Commercial |
$2,833.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,643.20
|
| Rate for Payer: Multiplan All |
$3,683.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,833.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,643.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,845.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,036.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,764.64
|
| Rate for Payer: Zelis Auto |
$1,619.20
|
|
|
IMPLT PLATE SHAFT MID SUPER RT 99MM 6HL
|
Facility
|
OP
|
$4,048.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.00 |
| Max. Negotiated Rate |
$3,845.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cigna Commercial |
$3,440.80
|
| Rate for Payer: First Health Commercial |
$3,643.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,643.20
|
| Rate for Payer: GEHA Commercial |
$3,238.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,643.20
|
| Rate for Payer: Humana ChoiceCare |
$1,052.48
|
| Rate for Payer: Multiplan All |
$3,683.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,428.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,833.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,643.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,845.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,036.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,562.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,012.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,764.64
|
| Rate for Payer: Zelis Auto |
$1,619.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,024.00
|
|
|
IMPLT PLATE SHAFT MID SUP LEFT 97MM 8H
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$3,564.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cigna Commercial |
$3,189.20
|
| Rate for Payer: First Health Commercial |
$3,376.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,376.80
|
| Rate for Payer: GEHA Commercial |
$3,001.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,376.80
|
| Rate for Payer: Humana ChoiceCare |
$975.52
|
| Rate for Payer: Multiplan All |
$3,414.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,251.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,626.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,376.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,564.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,814.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,301.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$938.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,489.36
|
| Rate for Payer: Zelis Auto |
$1,500.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,876.00
|
|
|
IMPLT PLATE SHAFT MID SUP LEFT 97MM 8H
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.80 |
| Max. Negotiated Rate |
$3,564.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,001.60
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cigna Commercial |
$3,189.20
|
| Rate for Payer: First Health Commercial |
$3,376.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,376.80
|
| Rate for Payer: GEHA Commercial |
$2,626.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,376.80
|
| Rate for Payer: Multiplan All |
$3,414.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,626.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,376.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,564.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,814.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,489.36
|
| Rate for Payer: Zelis Auto |
$1,500.80
|
|
|
IMPLT PLATE SHAFT MID SUP RIGHT 8HL 99MM
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.80 |
| Max. Negotiated Rate |
$3,564.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,001.60
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cigna Commercial |
$3,189.20
|
| Rate for Payer: First Health Commercial |
$3,376.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,376.80
|
| Rate for Payer: GEHA Commercial |
$2,626.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,376.80
|
| Rate for Payer: Multiplan All |
$3,414.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,626.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,376.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,564.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,814.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,489.36
|
| Rate for Payer: Zelis Auto |
$1,500.80
|
|
|
IMPLT PLATE SHAFT MID SUP RIGHT 8HL 99MM
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$3,564.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cigna Commercial |
$3,189.20
|
| Rate for Payer: First Health Commercial |
$3,376.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,376.80
|
| Rate for Payer: GEHA Commercial |
$3,001.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,376.80
|
| Rate for Payer: Humana ChoiceCare |
$975.52
|
| Rate for Payer: Multiplan All |
$3,414.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,251.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,626.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,376.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,564.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,814.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,301.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$938.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,489.36
|
| Rate for Payer: Zelis Auto |
$1,500.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,876.00
|
|
