|
IMPLT PLATE SHORT NARROW
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.00 |
| Max. Negotiated Rate |
$2,314.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cigna Commercial |
$2,070.60
|
| Rate for Payer: First Health Commercial |
$2,192.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,192.40
|
| Rate for Payer: GEHA Commercial |
$1,948.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,192.40
|
| Rate for Payer: Humana ChoiceCare |
$633.36
|
| Rate for Payer: Multiplan All |
$2,216.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,461.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,705.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,192.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,314.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,827.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,143.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$609.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,265.48
|
| Rate for Payer: Zelis Auto |
$974.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,218.00
|
|
|
IMPLT PLATE SHORT NARROW
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.40 |
| Max. Negotiated Rate |
$2,314.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,948.80
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cigna Commercial |
$2,070.60
|
| Rate for Payer: First Health Commercial |
$2,192.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,192.40
|
| Rate for Payer: GEHA Commercial |
$1,705.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,192.40
|
| Rate for Payer: Multiplan All |
$2,216.76
|
| Rate for Payer: OMNI Networks Commercial |
$1,705.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,192.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,314.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,827.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,265.48
|
| Rate for Payer: Zelis Auto |
$974.40
|
|
|
IMPLT PLATE SHORT UNIVERSAL LOCKING
|
Facility
|
OP
|
$2,959.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001209
|
|
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 SHORT UNIVERSAL LOCKING
|
Facility
|
IP
|
$2,959.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001209
|
|
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 SHRT 27MM 3.5MM SCR 6 HL
|
Facility
|
IP
|
$3,882.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.80 |
| Max. Negotiated Rate |
$3,687.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,105.60
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Cigna Commercial |
$3,299.70
|
| Rate for Payer: First Health Commercial |
$3,493.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,493.80
|
| Rate for Payer: GEHA Commercial |
$2,717.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,493.80
|
| Rate for Payer: Multiplan All |
$3,532.62
|
| Rate for Payer: OMNI Networks Commercial |
$2,717.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,493.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,687.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,911.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,610.26
|
| Rate for Payer: Zelis Auto |
$1,552.80
|
|
|
IMPLT PLATE SHRT 27MM 3.5MM SCR 6 HL
|
Facility
|
IP
|
$3,711.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,484.40 |
| Max. Negotiated Rate |
$3,525.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,968.80
|
| Rate for Payer: Cash Price |
$2,226.60
|
| Rate for Payer: Cash Price |
$2,226.60
|
| Rate for Payer: Cigna Commercial |
$3,154.35
|
| Rate for Payer: First Health Commercial |
$3,339.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,339.90
|
| Rate for Payer: GEHA Commercial |
$2,597.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,339.90
|
| Rate for Payer: Multiplan All |
$3,377.01
|
| Rate for Payer: OMNI Networks Commercial |
$2,597.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,339.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,525.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,783.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,451.23
|
| Rate for Payer: Zelis Auto |
$1,484.40
|
|
|
IMPLT PLATE SHRT 27MM 3.5MM SCR 6 HL
|
Facility
|
OP
|
$3,882.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.50 |
| Max. Negotiated Rate |
$3,687.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,329.20
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Cigna Commercial |
$3,299.70
|
| Rate for Payer: First Health Commercial |
$3,493.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,493.80
|
| Rate for Payer: GEHA Commercial |
$3,105.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,493.80
|
| Rate for Payer: Humana ChoiceCare |
$1,009.32
|
| Rate for Payer: Multiplan All |
$3,532.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,329.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,717.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,493.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,687.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,911.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,416.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$970.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,610.26
|
| Rate for Payer: Zelis Auto |
$1,552.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,941.00
|
|
|
IMPLT PLATE SHRT 27MM 3.5MM SCR 6 HL
|
Facility
|
OP
|
$3,711.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.75 |
| Max. Negotiated Rate |
$3,525.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,226.60
|
| Rate for Payer: Cash Price |
$2,226.60
|
| Rate for Payer: Cash Price |
$2,226.60
|
| Rate for Payer: Cigna Commercial |
$3,154.35
|
| Rate for Payer: First Health Commercial |
$3,339.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,339.90
|
| Rate for Payer: GEHA Commercial |
$2,968.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,339.90
|
| Rate for Payer: Humana ChoiceCare |
$964.86
|
| Rate for Payer: Multiplan All |
$3,377.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,226.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,597.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,339.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,525.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,783.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,265.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$927.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,451.23
|
| Rate for Payer: Zelis Auto |
$1,484.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,855.50
|
|
|
IMPLT PLATE SHRT 56MM TI 11 HL RIGHT
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.75 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,639.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Humana ChoiceCare |
$857.74
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,979.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,903.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$824.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,649.50
|
|
|
IMPLT PLATE SHRT 56MM TI 11 HL RIGHT
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,639.20
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$2,804.15
|
| Rate for Payer: First Health Commercial |
$2,969.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,969.10
|
| Rate for Payer: GEHA Commercial |
$2,309.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,969.10
|
| Rate for Payer: Multiplan All |
$3,002.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,309.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,134.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,474.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,068.07
|
| Rate for Payer: Zelis Auto |
$1,319.60
|
|
|
IMPLT PLATE SM 1MM 1.7MM 2X2 HL VARIAX
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,513.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
|
|
IMPLT PLATE SM 1MM 1.7MM 2X2 HL VARIAX
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.50 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,729.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$562.12
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,297.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,902.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$540.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,081.00
|
|
|
IMPLT PLATE SM 8-HOLE TUBULAR
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.75 |
| Max. Negotiated Rate |
$557.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$352.20
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cigna Commercial |
$498.95
|
| Rate for Payer: First Health Commercial |
$528.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$469.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| Rate for Payer: Humana ChoiceCare |
$152.62
|
| Rate for Payer: Multiplan All |
$534.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$352.20
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$557.65
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$516.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$146.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$545.91
|
| Rate for Payer: Zelis Auto |
$234.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$293.50
|
|
|
IMPLT PLATE SM 8-HOLE TUBULAR
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.80 |
| Max. Negotiated Rate |
$557.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$469.60
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cigna Commercial |
$498.95
|
| Rate for Payer: First Health Commercial |
$528.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$410.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| Rate for Payer: Multiplan All |
$534.17
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$557.65
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$545.91
|
| Rate for Payer: Zelis Auto |
$234.80
|
|
|
IMPLT PLATE SMALL 6 HOLE
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.00 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$716.00
|
| 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 |
$626.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Multiplan All |
$814.45
|
| 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: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
|
|
IMPLT PLATE SMALL 6 HOLE
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000417
|
|
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 SMALL LOCKING 3.5MM
|
Facility
|
OP
|
$2,690.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.50 |
| Max. Negotiated Rate |
$2,555.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,614.00
|
| Rate for Payer: Cash Price |
$1,614.00
|
| Rate for Payer: Cash Price |
$1,614.00
|
| Rate for Payer: Cigna Commercial |
$2,286.50
|
| Rate for Payer: First Health Commercial |
$2,421.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,421.00
|
| Rate for Payer: GEHA Commercial |
$2,152.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,421.00
|
| Rate for Payer: Humana ChoiceCare |
$699.40
|
| Rate for Payer: Multiplan All |
$2,447.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,614.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,883.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,421.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,555.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,017.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,367.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$672.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,501.70
|
| Rate for Payer: Zelis Auto |
$1,076.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,345.00
|
|
|
IMPLT PLATE SMALL LOCKING 3.5MM
|
Facility
|
IP
|
$2,690.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.00 |
| Max. Negotiated Rate |
$2,555.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,152.00
|
| Rate for Payer: Cash Price |
$1,614.00
|
| Rate for Payer: Cash Price |
$1,614.00
|
| Rate for Payer: Cigna Commercial |
$2,286.50
|
| Rate for Payer: First Health Commercial |
$2,421.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,421.00
|
| Rate for Payer: GEHA Commercial |
$1,883.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,421.00
|
| Rate for Payer: Multiplan All |
$2,447.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,883.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,421.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,555.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,017.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,501.70
|
| Rate for Payer: Zelis Auto |
$1,076.00
|
|
|
IMPLT PLATE SMALL MESH
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cigna Commercial |
$2,210.00
|
| Rate for Payer: First Health Commercial |
$2,340.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,340.00
|
| Rate for Payer: GEHA Commercial |
$2,080.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,340.00
|
| Rate for Payer: Humana ChoiceCare |
$676.00
|
| Rate for Payer: Multiplan All |
$2,366.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,560.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,820.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,340.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,470.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,950.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,288.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$650.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,418.00
|
| Rate for Payer: Zelis Auto |
$1,040.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,300.00
|
|
|
IMPLT PLATE SMALL MESH
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.00 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,080.00
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cigna Commercial |
$2,210.00
|
| Rate for Payer: First Health Commercial |
$2,340.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,340.00
|
| Rate for Payer: GEHA Commercial |
$1,820.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,340.00
|
| Rate for Payer: Multiplan All |
$2,366.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,820.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,340.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,470.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,950.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,418.00
|
| Rate for Payer: Zelis Auto |
$1,040.00
|
|
|
IMPLT PLATE S/N 3 HOLE RT.WIDE
|
Facility
|
IP
|
$2,786.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.40 |
| Max. Negotiated Rate |
$2,646.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,228.80
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cigna Commercial |
$2,368.10
|
| Rate for Payer: First Health Commercial |
$2,507.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,507.40
|
| Rate for Payer: GEHA Commercial |
$1,950.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,507.40
|
| Rate for Payer: Multiplan All |
$2,535.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,950.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,507.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,646.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,089.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,590.98
|
| Rate for Payer: Zelis Auto |
$1,114.40
|
|
|
IMPLT PLATE S/N 3 HOLE RT.WIDE
|
Facility
|
OP
|
$2,786.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$696.50 |
| Max. Negotiated Rate |
$2,646.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,671.60
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cigna Commercial |
$2,368.10
|
| Rate for Payer: First Health Commercial |
$2,507.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,507.40
|
| Rate for Payer: GEHA Commercial |
$2,228.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,507.40
|
| Rate for Payer: Humana ChoiceCare |
$724.36
|
| Rate for Payer: Multiplan All |
$2,535.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,671.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,950.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,507.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,646.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,089.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,451.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$696.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,590.98
|
| Rate for Payer: Zelis Auto |
$1,114.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,393.00
|
|
|
IMPLT PLATE SN PERI 8H 1/3 TUB
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$547.40
|
| Rate for Payer: First Health Commercial |
$579.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$579.60
|
| Rate for Payer: GEHA Commercial |
$515.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$579.60
|
| Rate for Payer: Humana ChoiceCare |
$167.44
|
| Rate for Payer: Multiplan All |
$586.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$386.40
|
| Rate for Payer: OMNI Networks Commercial |
$450.80
|
| Rate for Payer: One Health Plan PPO/POS |
$579.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$611.80
|
| Rate for Payer: Three Rivers Provider Network All |
$483.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$566.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$161.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$598.92
|
| Rate for Payer: Zelis Auto |
$257.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$322.00
|
|
|
IMPLT PLATE SN PERI 8H 1/3 TUB
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$515.20
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$547.40
|
| Rate for Payer: First Health Commercial |
$579.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$579.60
|
| Rate for Payer: GEHA Commercial |
$450.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$579.60
|
| Rate for Payer: Multiplan All |
$586.04
|
| Rate for Payer: OMNI Networks Commercial |
$450.80
|
| Rate for Payer: One Health Plan PPO/POS |
$579.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$611.80
|
| Rate for Payer: Three Rivers Provider Network All |
$483.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$598.92
|
| Rate for Payer: Zelis Auto |
$257.60
|
|
|
IMPLT PLATE STANDARD 2.3X1IN
|
Facility
|
IP
|
$2,437.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.80 |
| Max. Negotiated Rate |
$2,315.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,949.60
|
| Rate for Payer: Cash Price |
$1,462.20
|
| Rate for Payer: Cash Price |
$1,462.20
|
| Rate for Payer: Cigna Commercial |
$2,071.45
|
| Rate for Payer: First Health Commercial |
$2,193.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,193.30
|
| Rate for Payer: GEHA Commercial |
$1,705.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,193.30
|
| Rate for Payer: Multiplan All |
$2,217.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,705.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,193.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,315.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,827.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,266.41
|
| Rate for Payer: Zelis Auto |
$974.80
|
|
