|
IMPLT PLATE STRIKE 1806-0150
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.25 |
| Max. Negotiated Rate |
$779.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$492.60
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$697.85
|
| Rate for Payer: First Health Commercial |
$738.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.90
|
| Rate for Payer: GEHA Commercial |
$656.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.90
|
| Rate for Payer: Humana ChoiceCare |
$213.46
|
| Rate for Payer: Multiplan All |
$747.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$492.60
|
| Rate for Payer: OMNI Networks Commercial |
$574.70
|
| Rate for Payer: One Health Plan PPO/POS |
$738.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.95
|
| Rate for Payer: Three Rivers Provider Network All |
$615.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$722.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$205.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$763.53
|
| Rate for Payer: Zelis Auto |
$328.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$410.50
|
|
|
IMPLT PLATE STRIKE 1806-0150
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.40 |
| Max. Negotiated Rate |
$779.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$656.80
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$697.85
|
| Rate for Payer: First Health Commercial |
$738.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.90
|
| Rate for Payer: GEHA Commercial |
$574.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.90
|
| Rate for Payer: Multiplan All |
$747.11
|
| Rate for Payer: OMNI Networks Commercial |
$574.70
|
| Rate for Payer: One Health Plan PPO/POS |
$738.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.95
|
| Rate for Payer: Three Rivers Provider Network All |
$615.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$763.53
|
| Rate for Payer: Zelis Auto |
$328.40
|
|
|
IMPLT PLATES TUBULAR 12 HOLE 141MM
|
Facility
|
OP
|
$2,515.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$628.75 |
| Max. Negotiated Rate |
$2,389.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,509.00
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cigna Commercial |
$2,137.75
|
| Rate for Payer: First Health Commercial |
$2,263.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,263.50
|
| Rate for Payer: GEHA Commercial |
$2,012.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,263.50
|
| Rate for Payer: Humana ChoiceCare |
$653.90
|
| Rate for Payer: Multiplan All |
$2,288.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,509.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,760.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,263.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,389.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,886.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,213.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$628.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,338.95
|
| Rate for Payer: Zelis Auto |
$1,006.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,257.50
|
|
|
IMPLT PLATES TUBULAR 12 HOLE 141MM
|
Facility
|
IP
|
$2,515.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,006.00 |
| Max. Negotiated Rate |
$2,389.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,012.00
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cigna Commercial |
$2,137.75
|
| Rate for Payer: First Health Commercial |
$2,263.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,263.50
|
| Rate for Payer: GEHA Commercial |
$1,760.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,263.50
|
| Rate for Payer: Multiplan All |
$2,288.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,760.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,263.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,389.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,886.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,338.95
|
| Rate for Payer: Zelis Auto |
$1,006.00
|
|
|
IMPLT PLATE T 2.3MM HOLE 7
|
Facility
|
OP
|
$1,667.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.75 |
| Max. Negotiated Rate |
$1,583.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,000.20
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Cigna Commercial |
$1,416.95
|
| Rate for Payer: First Health Commercial |
$1,500.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,500.30
|
| Rate for Payer: GEHA Commercial |
$1,333.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,500.30
|
| Rate for Payer: Humana ChoiceCare |
$433.42
|
| Rate for Payer: Multiplan All |
$1,516.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,000.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,166.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,500.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,583.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,250.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,466.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$416.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,550.31
|
| Rate for Payer: Zelis Auto |
$666.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$833.50
|
|
|
IMPLT PLATE T 2.3MM HOLE 7
|
Facility
|
IP
|
$1,667.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.80 |
| Max. Negotiated Rate |
$1,583.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,333.60
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Cigna Commercial |
$1,416.95
|
| Rate for Payer: First Health Commercial |
$1,500.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,500.30
|
| Rate for Payer: GEHA Commercial |
$1,166.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,500.30
|
| Rate for Payer: Multiplan All |
$1,516.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,166.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,500.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,583.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,250.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,550.31
|
| Rate for Payer: Zelis Auto |
$666.80
|
|
|
IMPLT PLATE T 3.5MM 3 HOLE 53MM OBLIQUE
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.25 |
| Max. Negotiated Rate |
$1,159.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna Commercial |
$1,037.85
|
| Rate for Payer: First Health Commercial |
$1,098.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,098.90
|
| Rate for Payer: GEHA Commercial |
$976.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,098.90
|
| Rate for Payer: Humana ChoiceCare |
$317.46
|
| Rate for Payer: Multiplan All |
$1,111.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$732.60
|
| Rate for Payer: OMNI Networks Commercial |
$854.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,098.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,159.95
|
| Rate for Payer: Three Rivers Provider Network All |
$915.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,074.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$305.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,135.53
|
| Rate for Payer: Zelis Auto |
$488.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$610.50
|
|
|
IMPLT PLATE T 3.5MM 3 HOLE 53MM OBLIQUE
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$1,159.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$976.80
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna Commercial |
$1,037.85
|
| Rate for Payer: First Health Commercial |
$1,098.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,098.90
|
| Rate for Payer: GEHA Commercial |
$854.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,098.90
|
| Rate for Payer: Multiplan All |
$1,111.11
|
| Rate for Payer: OMNI Networks Commercial |
$854.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,098.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,159.95
|
| Rate for Payer: Three Rivers Provider Network All |
$915.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,135.53
|
| Rate for Payer: Zelis Auto |
$488.40
|
|
|
IMPLT PLATE TACK
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.50 |
| Max. Negotiated Rate |
$1,027.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$919.70
|
| Rate for Payer: First Health Commercial |
$973.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$973.80
|
| Rate for Payer: GEHA Commercial |
$865.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$973.80
|
| Rate for Payer: Humana ChoiceCare |
$281.32
|
| Rate for Payer: Multiplan All |
$984.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$649.20
|
| Rate for Payer: OMNI Networks Commercial |
$757.40
|
| Rate for Payer: One Health Plan PPO/POS |
$973.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,027.90
|
| Rate for Payer: Three Rivers Provider Network All |
$811.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$952.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$270.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,006.26
|
| Rate for Payer: Zelis Auto |
$432.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$541.00
|
|
|
IMPLT PLATE TACK
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.80 |
| Max. Negotiated Rate |
$1,027.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$865.60
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$919.70
|
| Rate for Payer: First Health Commercial |
$973.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$973.80
|
| Rate for Payer: GEHA Commercial |
$757.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$973.80
|
| Rate for Payer: Multiplan All |
$984.62
|
| Rate for Payer: OMNI Networks Commercial |
$757.40
|
| Rate for Payer: One Health Plan PPO/POS |
$973.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,027.90
|
| Rate for Payer: Three Rivers Provider Network All |
$811.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,006.26
|
| Rate for Payer: Zelis Auto |
$432.80
|
|
|
IMPLT PLATE T ANGLE RIGHT 35MM 3HOLE
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.75 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$726.75
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$769.50
|
| Rate for Payer: GEHA Commercial |
$684.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$769.50
|
| Rate for Payer: Humana ChoiceCare |
$222.30
|
| Rate for Payer: Multiplan All |
$778.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$513.00
|
| Rate for Payer: OMNI Networks Commercial |
$598.50
|
| Rate for Payer: One Health Plan PPO/POS |
$769.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$812.25
|
| Rate for Payer: Three Rivers Provider Network All |
$641.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$752.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$795.15
|
| Rate for Payer: Zelis Auto |
$342.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$427.50
|
|
|
IMPLT PLATE T ANGLE RIGHT 35MM 3HOLE
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$684.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$726.75
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$769.50
|
| Rate for Payer: GEHA Commercial |
$598.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$769.50
|
| Rate for Payer: Multiplan All |
$778.05
|
| Rate for Payer: OMNI Networks Commercial |
$598.50
|
| Rate for Payer: One Health Plan PPO/POS |
$769.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$812.25
|
| Rate for Payer: Three Rivers Provider Network All |
$641.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$795.15
|
| Rate for Payer: Zelis Auto |
$342.00
|
|
|
IMPLT PLATE T CURVED
|
Facility
|
OP
|
$2,493.72
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.43 |
| Max. Negotiated Rate |
$2,369.03 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,496.23
|
| Rate for Payer: Cash Price |
$1,496.23
|
| Rate for Payer: Cash Price |
$1,496.23
|
| Rate for Payer: Cigna Commercial |
$2,119.66
|
| Rate for Payer: First Health Commercial |
$2,244.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,244.35
|
| Rate for Payer: GEHA Commercial |
$1,994.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,244.35
|
| Rate for Payer: Humana ChoiceCare |
$648.37
|
| Rate for Payer: Multiplan All |
$2,269.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,496.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,745.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,244.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,369.03
|
| Rate for Payer: Three Rivers Provider Network All |
$1,870.29
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,194.47
|
| Rate for Payer: United Healthcare Managed Medicaid |
$623.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,319.16
|
| Rate for Payer: Zelis Auto |
$997.49
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,246.86
|
|
|
IMPLT PLATE T CURVED
|
Facility
|
IP
|
$2,493.72
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.49 |
| Max. Negotiated Rate |
$2,369.03 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,994.98
|
| Rate for Payer: Cash Price |
$1,496.23
|
| Rate for Payer: Cash Price |
$1,496.23
|
| Rate for Payer: Cigna Commercial |
$2,119.66
|
| Rate for Payer: First Health Commercial |
$2,244.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,244.35
|
| Rate for Payer: GEHA Commercial |
$1,745.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,244.35
|
| Rate for Payer: Multiplan All |
$2,269.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,745.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,244.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,369.03
|
| Rate for Payer: Three Rivers Provider Network All |
$1,870.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,319.16
|
| Rate for Payer: Zelis Auto |
$997.49
|
|
|
IMPLT PLATE T HOLE TWO 2.0MM
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.25 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$410.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| Rate for Payer: Humana ChoiceCare |
$133.38
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$307.80
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$451.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$128.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: Zelis Auto |
$205.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$256.50
|
|
|
IMPLT PLATE T HOLE TWO 2.0MM
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$410.40
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$461.70
|
| Rate for Payer: GEHA Commercial |
$359.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$461.70
|
| Rate for Payer: Multiplan All |
$466.83
|
| Rate for Payer: OMNI Networks Commercial |
$359.10
|
| Rate for Payer: One Health Plan PPO/POS |
$461.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$487.35
|
| Rate for Payer: Three Rivers Provider Network All |
$384.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$477.09
|
| Rate for Payer: Zelis Auto |
$205.20
|
|
|
IMPLT PLATE TIBIA 3.5X127MM
|
Facility
|
IP
|
$5,030.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,012.00 |
| Max. Negotiated Rate |
$4,778.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,024.00
|
| Rate for Payer: Cash Price |
$3,018.00
|
| Rate for Payer: Cash Price |
$3,018.00
|
| Rate for Payer: Cigna Commercial |
$4,275.50
|
| Rate for Payer: First Health Commercial |
$4,527.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,527.00
|
| Rate for Payer: GEHA Commercial |
$3,521.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,527.00
|
| Rate for Payer: Multiplan All |
$4,577.30
|
| Rate for Payer: OMNI Networks Commercial |
$3,521.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,527.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,778.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,772.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,677.90
|
| Rate for Payer: Zelis Auto |
$2,012.00
|
|
|
IMPLT PLATE TIBIA 3.5X127MM
|
Facility
|
OP
|
$5,030.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.50 |
| Max. Negotiated Rate |
$4,778.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,018.00
|
| Rate for Payer: Cash Price |
$3,018.00
|
| Rate for Payer: Cash Price |
$3,018.00
|
| Rate for Payer: Cigna Commercial |
$4,275.50
|
| Rate for Payer: First Health Commercial |
$4,527.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,527.00
|
| Rate for Payer: GEHA Commercial |
$4,024.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,527.00
|
| Rate for Payer: Humana ChoiceCare |
$1,307.80
|
| Rate for Payer: Multiplan All |
$4,577.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,018.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,521.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,527.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,778.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,772.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,426.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,257.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,677.90
|
| Rate for Payer: Zelis Auto |
$2,012.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,515.00
|
|
|
IMPLT PLATE TIBIA 3-HOLE X 47MM P-L VLP
|
Facility
|
IP
|
$3,790.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,516.00 |
| Max. Negotiated Rate |
$3,600.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,032.00
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$3,221.50
|
| Rate for Payer: First Health Commercial |
$3,411.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,411.00
|
| Rate for Payer: GEHA Commercial |
$2,653.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,411.00
|
| Rate for Payer: Multiplan All |
$3,448.90
|
| Rate for Payer: OMNI Networks Commercial |
$2,653.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,411.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,600.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,842.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,524.70
|
| Rate for Payer: Zelis Auto |
$1,516.00
|
|
|
IMPLT PLATE TIBIA 3-HOLE X 47MM P-L VLP
|
Facility
|
OP
|
$3,790.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.50 |
| Max. Negotiated Rate |
$3,600.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,274.00
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$3,221.50
|
| Rate for Payer: First Health Commercial |
$3,411.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,411.00
|
| Rate for Payer: GEHA Commercial |
$3,032.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,411.00
|
| Rate for Payer: Humana ChoiceCare |
$985.40
|
| Rate for Payer: Multiplan All |
$3,448.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,274.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,653.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,411.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,600.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,842.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,335.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$947.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,524.70
|
| Rate for Payer: Zelis Auto |
$1,516.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,895.00
|
|
|
IMPLT PLATE TIBIA 6 HOLE RIGHT 93MM
|
Facility
|
IP
|
$3,671.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.40 |
| Max. Negotiated Rate |
$3,487.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,936.80
|
| Rate for Payer: Cash Price |
$2,202.60
|
| Rate for Payer: Cash Price |
$2,202.60
|
| Rate for Payer: Cigna Commercial |
$3,120.35
|
| Rate for Payer: First Health Commercial |
$3,303.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,303.90
|
| Rate for Payer: GEHA Commercial |
$2,569.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,303.90
|
| Rate for Payer: Multiplan All |
$3,340.61
|
| Rate for Payer: OMNI Networks Commercial |
$2,569.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,303.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,487.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,753.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,414.03
|
| Rate for Payer: Zelis Auto |
$1,468.40
|
|
|
IMPLT PLATE TIBIA 6 HOLE RIGHT 93MM
|
Facility
|
OP
|
$3,671.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$917.75 |
| Max. Negotiated Rate |
$3,487.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,202.60
|
| Rate for Payer: Cash Price |
$2,202.60
|
| Rate for Payer: Cash Price |
$2,202.60
|
| Rate for Payer: Cigna Commercial |
$3,120.35
|
| Rate for Payer: First Health Commercial |
$3,303.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,303.90
|
| Rate for Payer: GEHA Commercial |
$2,936.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,303.90
|
| Rate for Payer: Humana ChoiceCare |
$954.46
|
| Rate for Payer: Multiplan All |
$3,340.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,202.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,569.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,303.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,487.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,753.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,230.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$917.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,414.03
|
| Rate for Payer: Zelis Auto |
$1,468.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,835.50
|
|
|
IMPLT PLATE TIBIAL A/P OSTEO
|
Facility
|
OP
|
$3,937.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.25 |
| Max. Negotiated Rate |
$3,740.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,362.20
|
| Rate for Payer: Cash Price |
$2,362.20
|
| Rate for Payer: Cash Price |
$2,362.20
|
| Rate for Payer: Cigna Commercial |
$3,346.45
|
| Rate for Payer: First Health Commercial |
$3,543.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,543.30
|
| Rate for Payer: GEHA Commercial |
$3,149.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,543.30
|
| Rate for Payer: Humana ChoiceCare |
$1,023.62
|
| Rate for Payer: Multiplan All |
$3,582.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,362.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,755.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,543.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,740.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,952.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,464.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$984.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,661.41
|
| Rate for Payer: Zelis Auto |
$1,574.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,968.50
|
|
|
IMPLT PLATE TIBIAL A/P OSTEO
|
Facility
|
IP
|
$3,937.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,574.80 |
| Max. Negotiated Rate |
$3,740.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,149.60
|
| Rate for Payer: Cash Price |
$2,362.20
|
| Rate for Payer: Cash Price |
$2,362.20
|
| Rate for Payer: Cigna Commercial |
$3,346.45
|
| Rate for Payer: First Health Commercial |
$3,543.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,543.30
|
| Rate for Payer: GEHA Commercial |
$2,755.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,543.30
|
| Rate for Payer: Multiplan All |
$3,582.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,755.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,543.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,740.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,952.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,661.41
|
| Rate for Payer: Zelis Auto |
$1,574.80
|
|
|
IMPLT PLATE TIBIAL LOCKING 3.5X123MM
|
Facility
|
OP
|
$5,310.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,327.50 |
| Max. Negotiated Rate |
$5,044.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,186.00
|
| Rate for Payer: Cash Price |
$3,186.00
|
| Rate for Payer: Cash Price |
$3,186.00
|
| Rate for Payer: Cigna Commercial |
$4,513.50
|
| Rate for Payer: First Health Commercial |
$4,779.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,779.00
|
| Rate for Payer: GEHA Commercial |
$4,248.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,779.00
|
| Rate for Payer: Humana ChoiceCare |
$1,380.60
|
| Rate for Payer: Multiplan All |
$4,832.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,186.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,717.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,779.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,044.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,982.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,672.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,327.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,938.30
|
| Rate for Payer: Zelis Auto |
$2,124.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,655.00
|
|
