|
IMPLT PLATE TUBULAR 3 HOLE 32MM
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.75 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$389.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Humana ChoiceCare |
$126.62
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$292.20
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$428.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: Zelis Auto |
$194.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$243.50
|
|
|
IMPLT PLATE TUBULAR 4HOLE 49MM
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.20 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$450.40
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cigna Commercial |
$478.55
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$506.70
|
| Rate for Payer: GEHA Commercial |
$394.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$506.70
|
| Rate for Payer: Multiplan All |
$512.33
|
| Rate for Payer: OMNI Networks Commercial |
$394.10
|
| Rate for Payer: One Health Plan PPO/POS |
$506.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$534.85
|
| Rate for Payer: Three Rivers Provider Network All |
$422.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$523.59
|
| Rate for Payer: Zelis Auto |
$225.20
|
|
|
IMPLT PLATE TUBULAR 4HOLE 49MM
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.75 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$337.80
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cigna Commercial |
$478.55
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$506.70
|
| Rate for Payer: GEHA Commercial |
$450.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$506.70
|
| Rate for Payer: Humana ChoiceCare |
$146.38
|
| Rate for Payer: Multiplan All |
$512.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$337.80
|
| Rate for Payer: OMNI Networks Commercial |
$394.10
|
| Rate for Payer: One Health Plan PPO/POS |
$506.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$534.85
|
| Rate for Payer: Three Rivers Provider Network All |
$422.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$495.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$140.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$523.59
|
| Rate for Payer: Zelis Auto |
$225.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.50
|
|
|
IMPLT PLATE TUBULAR 5 HOLE 39MM
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.80 |
| Max. Negotiated Rate |
$605.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$509.60
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$445.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| Rate for Payer: Multiplan All |
$579.67
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$605.15
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$592.41
|
| Rate for Payer: Zelis Auto |
$254.80
|
|
|
IMPLT PLATE TUBULAR 5 HOLE 39MM
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.25 |
| Max. Negotiated Rate |
$605.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$509.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| Rate for Payer: Humana ChoiceCare |
$165.62
|
| Rate for Payer: Multiplan All |
$579.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$382.20
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$605.15
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$560.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$592.41
|
| Rate for Payer: Zelis Auto |
$254.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$318.50
|
|
|
IMPLT PLATE TUBULAR 6 HOLE 47MM
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$436.80
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$464.10
|
| Rate for Payer: First Health Commercial |
$491.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$491.40
|
| Rate for Payer: GEHA Commercial |
$382.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$491.40
|
| Rate for Payer: Multiplan All |
$496.86
|
| Rate for Payer: OMNI Networks Commercial |
$382.20
|
| Rate for Payer: One Health Plan PPO/POS |
$491.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$518.70
|
| Rate for Payer: Three Rivers Provider Network All |
$409.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$507.78
|
| Rate for Payer: Zelis Auto |
$218.40
|
|
|
IMPLT PLATE TUBULAR 6 HOLE 47MM
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$464.10
|
| Rate for Payer: First Health Commercial |
$491.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$491.40
|
| Rate for Payer: GEHA Commercial |
$436.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$491.40
|
| Rate for Payer: Humana ChoiceCare |
$141.96
|
| Rate for Payer: Multiplan All |
$496.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.60
|
| Rate for Payer: OMNI Networks Commercial |
$382.20
|
| Rate for Payer: One Health Plan PPO/POS |
$491.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$518.70
|
| Rate for Payer: Three Rivers Provider Network All |
$409.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$480.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$136.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$507.78
|
| Rate for Payer: Zelis Auto |
$218.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.00
|
|
|
IMPLT PLATE TUBULAR 6 HOLE 69MM
|
Facility
|
IP
|
$994.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$397.60 |
| Max. Negotiated Rate |
$944.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$795.20
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cigna Commercial |
$844.90
|
| Rate for Payer: First Health Commercial |
$894.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$894.60
|
| Rate for Payer: GEHA Commercial |
$695.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$894.60
|
| Rate for Payer: Multiplan All |
$904.54
|
| Rate for Payer: OMNI Networks Commercial |
$695.80
|
| Rate for Payer: One Health Plan PPO/POS |
$894.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$944.30
|
| Rate for Payer: Three Rivers Provider Network All |
$745.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$924.42
|
| Rate for Payer: Zelis Auto |
$397.60
|
|
|
IMPLT PLATE TUBULAR 6 HOLE 69MM
|
Facility
|
OP
|
$994.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$944.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$596.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cigna Commercial |
$844.90
|
| Rate for Payer: First Health Commercial |
$894.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$894.60
|
| Rate for Payer: GEHA Commercial |
$795.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$894.60
|
| Rate for Payer: Humana ChoiceCare |
$258.44
|
| Rate for Payer: Multiplan All |
$904.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$596.40
|
| Rate for Payer: OMNI Networks Commercial |
$695.80
|
| Rate for Payer: One Health Plan PPO/POS |
$894.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$944.30
|
| Rate for Payer: Three Rivers Provider Network All |
$745.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$874.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$248.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$924.42
|
| Rate for Payer: Zelis Auto |
$397.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$497.00
|
|
|
IMPLT PLATE TUBULAR 7 HOLE 81MM
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000425
|
|
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 TUBULAR 7 HOLE 81MM
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000425
|
|
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 TUBULAR 8 HOLE
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT PLATE TUBULAR 8 HOLE
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT PLATE TUBULAR HOLE 6
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$329.00 |
| Max. Negotiated Rate |
$1,250.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$789.60
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cigna Commercial |
$1,118.60
|
| Rate for Payer: First Health Commercial |
$1,184.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,184.40
|
| Rate for Payer: GEHA Commercial |
$1,052.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,184.40
|
| Rate for Payer: Humana ChoiceCare |
$342.16
|
| Rate for Payer: Multiplan All |
$1,197.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$789.60
|
| Rate for Payer: OMNI Networks Commercial |
$921.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,184.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,250.20
|
| Rate for Payer: Three Rivers Provider Network All |
$987.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,158.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$329.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,223.88
|
| Rate for Payer: Zelis Auto |
$526.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$658.00
|
|
|
IMPLT PLATE TUBULAR HOLE 6
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.40 |
| Max. Negotiated Rate |
$1,250.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,052.80
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cigna Commercial |
$1,118.60
|
| Rate for Payer: First Health Commercial |
$1,184.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,184.40
|
| Rate for Payer: GEHA Commercial |
$921.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,184.40
|
| Rate for Payer: Multiplan All |
$1,197.56
|
| Rate for Payer: OMNI Networks Commercial |
$921.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,184.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,250.20
|
| Rate for Payer: Three Rivers Provider Network All |
$987.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,223.88
|
| Rate for Payer: Zelis Auto |
$526.40
|
|
|
IMPLT PLATE UNIV FRAC 64MM
|
Facility
|
IP
|
$2,419.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$967.60 |
| Max. Negotiated Rate |
$2,298.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,935.20
|
| Rate for Payer: Cash Price |
$1,451.40
|
| Rate for Payer: Cash Price |
$1,451.40
|
| Rate for Payer: Cigna Commercial |
$2,056.15
|
| Rate for Payer: First Health Commercial |
$2,177.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,177.10
|
| Rate for Payer: GEHA Commercial |
$1,693.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,177.10
|
| Rate for Payer: Multiplan All |
$2,201.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,693.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,177.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,298.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,814.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,249.67
|
| Rate for Payer: Zelis Auto |
$967.60
|
|
|
IMPLT PLATE UNIV FRAC 64MM
|
Facility
|
OP
|
$2,419.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.75 |
| Max. Negotiated Rate |
$2,298.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,451.40
|
| Rate for Payer: Cash Price |
$1,451.40
|
| Rate for Payer: Cash Price |
$1,451.40
|
| Rate for Payer: Cigna Commercial |
$2,056.15
|
| Rate for Payer: First Health Commercial |
$2,177.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,177.10
|
| Rate for Payer: GEHA Commercial |
$1,935.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,177.10
|
| Rate for Payer: Humana ChoiceCare |
$628.94
|
| Rate for Payer: Multiplan All |
$2,201.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,451.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,693.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,177.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,298.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,814.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,128.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$604.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,249.67
|
| Rate for Payer: Zelis Auto |
$967.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,209.50
|
|
|
IMPLT PLATE VARIAX BN 3 HOLE 72MM
|
Facility
|
OP
|
$3,239.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.75 |
| Max. Negotiated Rate |
$3,077.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,943.40
|
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cigna Commercial |
$2,753.15
|
| Rate for Payer: First Health Commercial |
$2,915.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,915.10
|
| Rate for Payer: GEHA Commercial |
$2,591.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,915.10
|
| Rate for Payer: Humana ChoiceCare |
$842.14
|
| Rate for Payer: Multiplan All |
$2,947.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,943.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,267.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,915.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,077.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,429.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,850.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$809.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,012.27
|
| Rate for Payer: Zelis Auto |
$1,295.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,619.50
|
|
|
IMPLT PLATE VARIAX BN 3 HOLE 72MM
|
Facility
|
IP
|
$3,239.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.60 |
| Max. Negotiated Rate |
$3,077.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,591.20
|
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cigna Commercial |
$2,753.15
|
| Rate for Payer: First Health Commercial |
$2,915.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,915.10
|
| Rate for Payer: GEHA Commercial |
$2,267.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,915.10
|
| Rate for Payer: Multiplan All |
$2,947.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,267.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,915.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,077.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,429.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,012.27
|
| Rate for Payer: Zelis Auto |
$1,295.60
|
|
|
IMPLT PLATE VARIAX BN 3 HOLE 81MM
|
Facility
|
IP
|
$3,239.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.60 |
| Max. Negotiated Rate |
$3,077.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,591.20
|
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cigna Commercial |
$2,753.15
|
| Rate for Payer: First Health Commercial |
$2,915.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,915.10
|
| Rate for Payer: GEHA Commercial |
$2,267.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,915.10
|
| Rate for Payer: Multiplan All |
$2,947.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,267.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,915.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,077.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,429.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,012.27
|
| Rate for Payer: Zelis Auto |
$1,295.60
|
|
|
IMPLT PLATE VARIAX BN 3 HOLE 81MM
|
Facility
|
OP
|
$3,239.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.75 |
| Max. Negotiated Rate |
$3,077.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,943.40
|
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cigna Commercial |
$2,753.15
|
| Rate for Payer: First Health Commercial |
$2,915.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,915.10
|
| Rate for Payer: GEHA Commercial |
$2,591.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,915.10
|
| Rate for Payer: Humana ChoiceCare |
$842.14
|
| Rate for Payer: Multiplan All |
$2,947.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,943.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,267.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,915.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,077.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,429.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,850.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$809.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,012.27
|
| Rate for Payer: Zelis Auto |
$1,295.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,619.50
|
|
|
IMPLT PLATE VARIAX HOLE 10
|
Facility
|
IP
|
$2,095.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009031
|
|
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 VARIAX HOLE 10
|
Facility
|
OP
|
$2,095.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009031
|
|
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 VARIAX HOLE 7
|
Facility
|
OP
|
$2,023.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.75 |
| Max. Negotiated Rate |
$1,921.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,213.80
|
| Rate for Payer: Cash Price |
$1,213.80
|
| Rate for Payer: Cash Price |
$1,213.80
|
| Rate for Payer: Cigna Commercial |
$1,719.55
|
| Rate for Payer: First Health Commercial |
$1,820.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,820.70
|
| Rate for Payer: GEHA Commercial |
$1,618.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,820.70
|
| Rate for Payer: Humana ChoiceCare |
$525.98
|
| Rate for Payer: Multiplan All |
$1,840.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,213.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,416.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,820.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,921.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,517.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,780.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$505.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,881.39
|
| Rate for Payer: Zelis Auto |
$809.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,011.50
|
|
|
IMPLT PLATE VARIAX HOLE 7
|
Facility
|
IP
|
$2,023.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.20 |
| Max. Negotiated Rate |
$1,921.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,618.40
|
| Rate for Payer: Cash Price |
$1,213.80
|
| Rate for Payer: Cash Price |
$1,213.80
|
| Rate for Payer: Cigna Commercial |
$1,719.55
|
| Rate for Payer: First Health Commercial |
$1,820.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,820.70
|
| Rate for Payer: GEHA Commercial |
$1,416.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,820.70
|
| Rate for Payer: Multiplan All |
$1,840.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,416.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,820.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,921.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,517.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,881.39
|
| Rate for Payer: Zelis Auto |
$809.20
|
|
