|
IMPLT PLATE STANDARD 2.3X1IN
|
Facility
|
OP
|
$2,437.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.25 |
| Max. Negotiated Rate |
$2,315.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,462.20
|
| 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 |
$1,949.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,193.30
|
| Rate for Payer: Humana ChoiceCare |
$633.62
|
| Rate for Payer: Multiplan All |
$2,217.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,462.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$2,144.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$609.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,266.41
|
| Rate for Payer: Zelis Auto |
$974.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,218.50
|
|
|
IMPLT PLATE,STANDARD,5HOLE,RIGHT
|
Facility
|
IP
|
$4,126.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.40 |
| Max. Negotiated Rate |
$3,919.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,300.80
|
| Rate for Payer: Cash Price |
$2,475.60
|
| Rate for Payer: Cash Price |
$2,475.60
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: First Health Commercial |
$3,713.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,713.40
|
| Rate for Payer: GEHA Commercial |
$2,888.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,713.40
|
| Rate for Payer: Multiplan All |
$3,754.66
|
| Rate for Payer: OMNI Networks Commercial |
$2,888.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,713.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,919.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,094.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,837.18
|
| Rate for Payer: Zelis Auto |
$1,650.40
|
|
|
IMPLT PLATE,STANDARD,5HOLE,RIGHT
|
Facility
|
OP
|
$4,126.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$3,919.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,475.60
|
| Rate for Payer: Cash Price |
$2,475.60
|
| Rate for Payer: Cash Price |
$2,475.60
|
| Rate for Payer: Cigna Commercial |
$3,507.10
|
| Rate for Payer: First Health Commercial |
$3,713.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,713.40
|
| Rate for Payer: GEHA Commercial |
$3,300.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,713.40
|
| Rate for Payer: Humana ChoiceCare |
$1,072.76
|
| Rate for Payer: Multiplan All |
$3,754.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,475.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,888.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,713.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,919.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,094.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,630.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,031.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,837.18
|
| Rate for Payer: Zelis Auto |
$1,650.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,063.00
|
|
|
IMPLT PLATE STANDARD 9HOLE RIGHT
|
Facility
|
IP
|
$8,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,264.40 |
| Max. Negotiated Rate |
$7,752.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,528.80
|
| Rate for Payer: Cash Price |
$4,896.60
|
| Rate for Payer: Cash Price |
$4,896.60
|
| Rate for Payer: Cigna Commercial |
$6,936.85
|
| Rate for Payer: First Health Commercial |
$7,344.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,344.90
|
| Rate for Payer: GEHA Commercial |
$5,712.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,344.90
|
| Rate for Payer: Multiplan All |
$7,426.51
|
| Rate for Payer: OMNI Networks Commercial |
$5,712.70
|
| Rate for Payer: One Health Plan PPO/POS |
$7,344.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,752.95
|
| Rate for Payer: Three Rivers Provider Network All |
$6,120.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,589.73
|
| Rate for Payer: Zelis Auto |
$3,264.40
|
|
|
IMPLT PLATE STANDARD 9HOLE RIGHT
|
Facility
|
OP
|
$8,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.25 |
| Max. Negotiated Rate |
$7,752.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,896.60
|
| Rate for Payer: Cash Price |
$4,896.60
|
| Rate for Payer: Cash Price |
$4,896.60
|
| Rate for Payer: Cigna Commercial |
$6,936.85
|
| Rate for Payer: First Health Commercial |
$7,344.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,344.90
|
| Rate for Payer: GEHA Commercial |
$6,528.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,344.90
|
| Rate for Payer: Humana ChoiceCare |
$2,121.86
|
| Rate for Payer: Multiplan All |
$7,426.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,896.60
|
| Rate for Payer: OMNI Networks Commercial |
$5,712.70
|
| Rate for Payer: One Health Plan PPO/POS |
$7,344.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,752.95
|
| Rate for Payer: Three Rivers Provider Network All |
$6,120.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,181.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,589.73
|
| Rate for Payer: Zelis Auto |
$3,264.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,080.50
|
|
|
IMPLT PLATE STANDARD SMALL 1.7MM
|
Facility
|
OP
|
$1,776.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002501
|
|
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 STANDARD SMALL 1.7MM
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002501
|
|
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 STD 3H LEFT 62MM
|
Facility
|
IP
|
$4,524.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,809.60 |
| Max. Negotiated Rate |
$4,297.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,619.20
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cigna Commercial |
$3,845.40
|
| Rate for Payer: First Health Commercial |
$4,071.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,071.60
|
| Rate for Payer: GEHA Commercial |
$3,166.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,071.60
|
| Rate for Payer: Multiplan All |
$4,116.84
|
| Rate for Payer: OMNI Networks Commercial |
$3,166.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,071.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,297.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,393.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,207.32
|
| Rate for Payer: Zelis Auto |
$1,809.60
|
|
|
IMPLT PLATE STD 3H LEFT 62MM
|
Facility
|
OP
|
$4,524.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,131.00 |
| Max. Negotiated Rate |
$4,297.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,714.40
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cigna Commercial |
$3,845.40
|
| Rate for Payer: First Health Commercial |
$4,071.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,071.60
|
| Rate for Payer: GEHA Commercial |
$3,619.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,071.60
|
| Rate for Payer: Humana ChoiceCare |
$1,176.24
|
| Rate for Payer: Multiplan All |
$4,116.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,714.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,166.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,071.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,297.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,393.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,981.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,131.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,207.32
|
| Rate for Payer: Zelis Auto |
$1,809.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,262.00
|
|
|
IMPLT PLATE STD 3H RGHT 62MM
|
Facility
|
IP
|
$2,284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.60 |
| Max. Negotiated Rate |
$2,169.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,827.20
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cigna Commercial |
$1,941.40
|
| Rate for Payer: First Health Commercial |
$2,055.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,055.60
|
| Rate for Payer: GEHA Commercial |
$1,598.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,055.60
|
| Rate for Payer: Multiplan All |
$2,078.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,055.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,169.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,713.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,124.12
|
| Rate for Payer: Zelis Auto |
$913.60
|
|
|
IMPLT PLATE STD 3H RGHT 62MM
|
Facility
|
OP
|
$2,284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.00 |
| Max. Negotiated Rate |
$2,169.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cigna Commercial |
$1,941.40
|
| Rate for Payer: First Health Commercial |
$2,055.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,055.60
|
| Rate for Payer: GEHA Commercial |
$1,827.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,055.60
|
| Rate for Payer: Humana ChoiceCare |
$593.84
|
| Rate for Payer: Multiplan All |
$2,078.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,370.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,055.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,169.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,713.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,009.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$571.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,124.12
|
| Rate for Payer: Zelis Auto |
$913.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,142.00
|
|
|
IMPLT PLATE STR 2.0MM 5HOLE
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$381.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Humana ChoiceCare |
$124.02
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$286.20
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$419.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$238.50
|
|
|
IMPLT PLATE STR 2.0MM 5HOLE
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$381.60
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$333.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
|
|
IMPLT PLATE STRAIGHT 16 HOLE
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000420
|
|
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 STRAIGHT 16 HOLE
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000420
|
|
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 STRAIGHT 2.0MM
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002534
|
|
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 STRAIGHT 2.0MM
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002534
|
|
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 STRAIGHT HOLE 10
|
Facility
|
IP
|
$2,095.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.00 |
| Max. Negotiated Rate |
$1,990.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,676.00
|
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cigna Commercial |
$1,780.75
|
| Rate for Payer: First Health Commercial |
$1,885.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,885.50
|
| Rate for Payer: GEHA Commercial |
$1,466.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,885.50
|
| Rate for Payer: Multiplan All |
$1,906.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,466.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,885.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,990.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,571.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,948.35
|
| Rate for Payer: Zelis Auto |
$838.00
|
|
|
IMPLT PLATE STRAIGHT HOLE 10
|
Facility
|
OP
|
$2,095.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.75 |
| Max. Negotiated Rate |
$1,990.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,257.00
|
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cigna Commercial |
$1,780.75
|
| Rate for Payer: First Health Commercial |
$1,885.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,885.50
|
| Rate for Payer: GEHA Commercial |
$1,676.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,885.50
|
| Rate for Payer: Humana ChoiceCare |
$544.70
|
| Rate for Payer: Multiplan All |
$1,906.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,257.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,466.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,885.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,990.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,571.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,843.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$523.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,948.35
|
| Rate for Payer: Zelis Auto |
$838.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,047.50
|
|
|
IMPLT PLATE STRAIGHT HOLE 5
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.75 |
| Max. Negotiated Rate |
$1,925.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,216.20
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cigna Commercial |
$1,722.95
|
| Rate for Payer: First Health Commercial |
$1,824.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,824.30
|
| Rate for Payer: GEHA Commercial |
$1,621.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,824.30
|
| Rate for Payer: Humana ChoiceCare |
$527.02
|
| Rate for Payer: Multiplan All |
$1,844.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,216.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,418.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,824.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,925.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,520.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,783.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$506.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,885.11
|
| Rate for Payer: Zelis Auto |
$810.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,013.50
|
|
|
IMPLT PLATE STRAIGHT HOLE 5
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$810.80 |
| Max. Negotiated Rate |
$1,925.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,621.60
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cigna Commercial |
$1,722.95
|
| Rate for Payer: First Health Commercial |
$1,824.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,824.30
|
| Rate for Payer: GEHA Commercial |
$1,418.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,824.30
|
| Rate for Payer: Multiplan All |
$1,844.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,418.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,824.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,925.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,520.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,885.11
|
| Rate for Payer: Zelis Auto |
$810.80
|
|
|
IMPLT PLATE STRAIGHT MEDIUM HOLE 4
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Humana ChoiceCare |
$340.34
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$785.40
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,151.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$327.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$654.50
|
|
|
IMPLT PLATE STRAIGHT MEDIUM HOLE 4
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,047.20
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
|
|
IMPLT PLATE STRAIGHT NARROW 1.5X2.3MM
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002631
|
|
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 STRAIGHT NARROW 1.5X2.3MM
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002631
|
|
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
|
|
