|
IMPLT PLATE VOLAR RIGHT
|
Facility
|
OP
|
$3,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.75 |
| Max. Negotiated Rate |
$3,035.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,917.00
|
| Rate for Payer: Cash Price |
$1,917.00
|
| Rate for Payer: Cash Price |
$1,917.00
|
| Rate for Payer: Cigna Commercial |
$2,715.75
|
| Rate for Payer: First Health Commercial |
$2,875.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,875.50
|
| Rate for Payer: GEHA Commercial |
$2,556.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,875.50
|
| Rate for Payer: Humana ChoiceCare |
$830.70
|
| Rate for Payer: Multiplan All |
$2,907.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,917.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,236.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,875.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,035.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,396.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,811.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$798.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,971.35
|
| Rate for Payer: Zelis Auto |
$1,278.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,597.50
|
|
|
IMPLT PLATE VOLAR RIGHT
|
Facility
|
OP
|
$3,136.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$784.00 |
| Max. Negotiated Rate |
$2,979.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,881.60
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cigna Commercial |
$2,665.60
|
| Rate for Payer: First Health Commercial |
$2,822.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,822.40
|
| Rate for Payer: GEHA Commercial |
$2,508.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,822.40
|
| Rate for Payer: Humana ChoiceCare |
$815.36
|
| Rate for Payer: Multiplan All |
$2,853.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,881.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,195.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,822.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,979.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,352.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,759.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$784.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,916.48
|
| Rate for Payer: Zelis Auto |
$1,254.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,568.00
|
|
|
IMPLT PLATE VOLAR RIGHT
|
Facility
|
IP
|
$3,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.00 |
| Max. Negotiated Rate |
$3,035.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,556.00
|
| Rate for Payer: Cash Price |
$1,917.00
|
| Rate for Payer: Cash Price |
$1,917.00
|
| Rate for Payer: Cigna Commercial |
$2,715.75
|
| Rate for Payer: First Health Commercial |
$2,875.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,875.50
|
| Rate for Payer: GEHA Commercial |
$2,236.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,875.50
|
| Rate for Payer: Multiplan All |
$2,907.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,236.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,875.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,035.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,396.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,971.35
|
| Rate for Payer: Zelis Auto |
$1,278.00
|
|
|
IMPLT PLATE VOLAR RIGHT
|
Facility
|
IP
|
$3,136.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,254.40 |
| Max. Negotiated Rate |
$2,979.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,508.80
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cigna Commercial |
$2,665.60
|
| Rate for Payer: First Health Commercial |
$2,822.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,822.40
|
| Rate for Payer: GEHA Commercial |
$2,195.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,822.40
|
| Rate for Payer: Multiplan All |
$2,853.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,195.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,822.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,979.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,352.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,916.48
|
| Rate for Payer: Zelis Auto |
$1,254.40
|
|
|
IMPLT PLATE WEDGE 0 DEGREE
|
Facility
|
OP
|
$6,684.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,671.00 |
| Max. Negotiated Rate |
$6,349.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,010.40
|
| Rate for Payer: Cash Price |
$4,010.40
|
| Rate for Payer: Cash Price |
$4,010.40
|
| Rate for Payer: Cigna Commercial |
$5,681.40
|
| Rate for Payer: First Health Commercial |
$6,015.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,015.60
|
| Rate for Payer: GEHA Commercial |
$5,347.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,015.60
|
| Rate for Payer: Humana ChoiceCare |
$1,737.84
|
| Rate for Payer: Multiplan All |
$6,082.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,010.40
|
| Rate for Payer: OMNI Networks Commercial |
$4,678.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,015.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,349.80
|
| Rate for Payer: Three Rivers Provider Network All |
$5,013.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,881.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,671.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,216.12
|
| Rate for Payer: Zelis Auto |
$2,673.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,342.00
|
|
|
IMPLT PLATE WEDGE 0 DEGREE
|
Facility
|
IP
|
$6,684.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.60 |
| Max. Negotiated Rate |
$6,349.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,347.20
|
| Rate for Payer: Cash Price |
$4,010.40
|
| Rate for Payer: Cash Price |
$4,010.40
|
| Rate for Payer: Cigna Commercial |
$5,681.40
|
| Rate for Payer: First Health Commercial |
$6,015.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,015.60
|
| Rate for Payer: GEHA Commercial |
$4,678.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,015.60
|
| Rate for Payer: Multiplan All |
$6,082.44
|
| Rate for Payer: OMNI Networks Commercial |
$4,678.80
|
| Rate for Payer: One Health Plan PPO/POS |
$6,015.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,349.80
|
| Rate for Payer: Three Rivers Provider Network All |
$5,013.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,216.12
|
| Rate for Payer: Zelis Auto |
$2,673.60
|
|
|
IMPLT PLATE WEDGE OSTEOTOMY FEMORAL
|
Facility
|
OP
|
$4,656.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.00 |
| Max. Negotiated Rate |
$4,423.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,793.60
|
| Rate for Payer: Cash Price |
$2,793.60
|
| Rate for Payer: Cash Price |
$2,793.60
|
| Rate for Payer: Cigna Commercial |
$3,957.60
|
| Rate for Payer: First Health Commercial |
$4,190.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,190.40
|
| Rate for Payer: GEHA Commercial |
$3,724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,190.40
|
| Rate for Payer: Humana ChoiceCare |
$1,210.56
|
| Rate for Payer: Multiplan All |
$4,236.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,793.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,259.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,190.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,423.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,492.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,097.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,164.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,330.08
|
| Rate for Payer: Zelis Auto |
$1,862.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,328.00
|
|
|
IMPLT PLATE WEDGE OSTEOTOMY FEMORAL
|
Facility
|
IP
|
$4,656.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,862.40 |
| Max. Negotiated Rate |
$4,423.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,724.80
|
| Rate for Payer: Cash Price |
$2,793.60
|
| Rate for Payer: Cash Price |
$2,793.60
|
| Rate for Payer: Cigna Commercial |
$3,957.60
|
| Rate for Payer: First Health Commercial |
$4,190.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,190.40
|
| Rate for Payer: GEHA Commercial |
$3,259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,190.40
|
| Rate for Payer: Multiplan All |
$4,236.96
|
| Rate for Payer: OMNI Networks Commercial |
$3,259.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,190.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,423.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,492.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,330.08
|
| Rate for Payer: Zelis Auto |
$1,862.40
|
|
|
IMPLT PLATE WEDGE OSTEOTOMY OPENG
|
Facility
|
OP
|
$3,937.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003034
|
|
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 WEDGE OSTEOTOMY OPENG
|
Facility
|
IP
|
$3,937.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003034
|
|
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 WIDE LEFT 3HOLE 62MM
|
Facility
|
OP
|
$2,440.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.00 |
| Max. Negotiated Rate |
$2,318.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,464.00
|
| Rate for Payer: Cash Price |
$1,464.00
|
| Rate for Payer: Cash Price |
$1,464.00
|
| Rate for Payer: Cigna Commercial |
$2,074.00
|
| Rate for Payer: First Health Commercial |
$2,196.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,196.00
|
| Rate for Payer: GEHA Commercial |
$1,952.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,196.00
|
| Rate for Payer: Humana ChoiceCare |
$634.40
|
| Rate for Payer: Multiplan All |
$2,220.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,464.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,708.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,196.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,318.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,830.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,147.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$610.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,269.20
|
| Rate for Payer: Zelis Auto |
$976.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,220.00
|
|
|
IMPLT PLATE WIDE LEFT 3HOLE 62MM
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.00 |
| Max. Negotiated Rate |
$2,242.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cigna Commercial |
$2,006.00
|
| Rate for Payer: First Health Commercial |
$2,124.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,124.00
|
| Rate for Payer: GEHA Commercial |
$1,888.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,124.00
|
| Rate for Payer: Humana ChoiceCare |
$613.60
|
| Rate for Payer: Multiplan All |
$2,147.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,416.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,652.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,124.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,242.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,770.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,076.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$590.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,194.80
|
| Rate for Payer: Zelis Auto |
$944.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,180.00
|
|
|
IMPLT PLATE WIDE LEFT 3HOLE 62MM
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.00 |
| Max. Negotiated Rate |
$2,242.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,888.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cigna Commercial |
$2,006.00
|
| Rate for Payer: First Health Commercial |
$2,124.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,124.00
|
| Rate for Payer: GEHA Commercial |
$1,652.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,124.00
|
| Rate for Payer: Multiplan All |
$2,147.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,652.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,124.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,242.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,770.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,194.80
|
| Rate for Payer: Zelis Auto |
$944.00
|
|
|
IMPLT PLATE WIDE LEFT 3HOLE 62MM
|
Facility
|
IP
|
$2,440.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.00 |
| Max. Negotiated Rate |
$2,318.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,952.00
|
| Rate for Payer: Cash Price |
$1,464.00
|
| Rate for Payer: Cash Price |
$1,464.00
|
| Rate for Payer: Cigna Commercial |
$2,074.00
|
| Rate for Payer: First Health Commercial |
$2,196.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,196.00
|
| Rate for Payer: GEHA Commercial |
$1,708.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,196.00
|
| Rate for Payer: Multiplan All |
$2,220.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,708.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,196.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,318.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,830.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,269.20
|
| Rate for Payer: Zelis Auto |
$976.00
|
|
|
IMPLT PLATE WIDE LEFT 5HOLE 86MM
|
Facility
|
OP
|
$4,495.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.75 |
| Max. Negotiated Rate |
$4,270.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,697.00
|
| Rate for Payer: Cash Price |
$2,697.00
|
| Rate for Payer: Cash Price |
$2,697.00
|
| Rate for Payer: Cigna Commercial |
$3,820.75
|
| Rate for Payer: First Health Commercial |
$4,045.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,045.50
|
| Rate for Payer: GEHA Commercial |
$3,596.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,045.50
|
| Rate for Payer: Humana ChoiceCare |
$1,168.70
|
| Rate for Payer: Multiplan All |
$4,090.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,697.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,146.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,045.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,270.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,371.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,955.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,123.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,180.35
|
| Rate for Payer: Zelis Auto |
$1,798.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,247.50
|
|
|
IMPLT PLATE WIDE LEFT 5HOLE 86MM
|
Facility
|
IP
|
$4,495.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,798.00 |
| Max. Negotiated Rate |
$4,270.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,596.00
|
| Rate for Payer: Cash Price |
$2,697.00
|
| Rate for Payer: Cash Price |
$2,697.00
|
| Rate for Payer: Cigna Commercial |
$3,820.75
|
| Rate for Payer: First Health Commercial |
$4,045.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,045.50
|
| Rate for Payer: GEHA Commercial |
$3,146.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,045.50
|
| Rate for Payer: Multiplan All |
$4,090.45
|
| Rate for Payer: OMNI Networks Commercial |
$3,146.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,045.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,270.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,371.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,180.35
|
| Rate for Payer: Zelis Auto |
$1,798.00
|
|
|
IMPLT PLATE WIDE LEFT 5HOLE 86MM
|
Facility
|
IP
|
$4,757.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,902.80 |
| Max. Negotiated Rate |
$4,519.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,805.60
|
| Rate for Payer: Cash Price |
$2,854.20
|
| Rate for Payer: Cash Price |
$2,854.20
|
| Rate for Payer: Cigna Commercial |
$4,043.45
|
| Rate for Payer: First Health Commercial |
$4,281.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,281.30
|
| Rate for Payer: GEHA Commercial |
$3,329.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,281.30
|
| Rate for Payer: Multiplan All |
$4,328.87
|
| Rate for Payer: OMNI Networks Commercial |
$3,329.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,281.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,519.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,567.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,424.01
|
| Rate for Payer: Zelis Auto |
$1,902.80
|
|
|
IMPLT PLATE WIDE LEFT 5HOLE 86MM
|
Facility
|
OP
|
$4,757.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.25 |
| Max. Negotiated Rate |
$4,519.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,854.20
|
| Rate for Payer: Cash Price |
$2,854.20
|
| Rate for Payer: Cash Price |
$2,854.20
|
| Rate for Payer: Cigna Commercial |
$4,043.45
|
| Rate for Payer: First Health Commercial |
$4,281.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,281.30
|
| Rate for Payer: GEHA Commercial |
$3,805.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,281.30
|
| Rate for Payer: Humana ChoiceCare |
$1,236.82
|
| Rate for Payer: Multiplan All |
$4,328.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,854.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,329.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,281.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,519.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,567.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,186.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,189.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,424.01
|
| Rate for Payer: Zelis Auto |
$1,902.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,378.50
|
|
|
IMPLT PLATE WIDE RIGHT 5HOLE 86MM
|
Facility
|
OP
|
$2,284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000430
|
|
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 WIDE RIGHT 5HOLE 86MM
|
Facility
|
IP
|
$2,284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000430
|
|
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 WIDE THREE HOLE 62MM
|
Facility
|
IP
|
$4,278.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,711.20 |
| Max. Negotiated Rate |
$4,064.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,422.40
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cigna Commercial |
$3,636.30
|
| Rate for Payer: First Health Commercial |
$3,850.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,850.20
|
| Rate for Payer: GEHA Commercial |
$2,994.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,850.20
|
| Rate for Payer: Multiplan All |
$3,892.98
|
| Rate for Payer: OMNI Networks Commercial |
$2,994.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,850.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,064.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,978.54
|
| Rate for Payer: Zelis Auto |
$1,711.20
|
|
|
IMPLT PLATE WIDE THREE HOLE 62MM
|
Facility
|
IP
|
$2,284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007024
|
|
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 WIDE THREE HOLE 62MM
|
Facility
|
OP
|
$2,284.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007024
|
|
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 WIDE THREE HOLE 62MM
|
Facility
|
OP
|
$4,278.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.50 |
| Max. Negotiated Rate |
$4,064.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cigna Commercial |
$3,636.30
|
| Rate for Payer: First Health Commercial |
$3,850.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,850.20
|
| Rate for Payer: GEHA Commercial |
$3,422.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,850.20
|
| Rate for Payer: Humana ChoiceCare |
$1,112.28
|
| Rate for Payer: Multiplan All |
$3,892.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,566.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,994.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,850.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,064.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,208.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,764.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,069.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,978.54
|
| Rate for Payer: Zelis Auto |
$1,711.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,139.00
|
|
|
IMPLT PLATE WRIST CARPAL MEDIUM
|
Facility
|
IP
|
$14,762.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,904.80 |
| Max. Negotiated Rate |
$14,023.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11,809.60
|
| Rate for Payer: Cash Price |
$8,857.20
|
| Rate for Payer: Cash Price |
$8,857.20
|
| Rate for Payer: Cigna Commercial |
$12,547.70
|
| Rate for Payer: First Health Commercial |
$13,285.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,285.80
|
| Rate for Payer: GEHA Commercial |
$10,333.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,285.80
|
| Rate for Payer: Multiplan All |
$13,433.42
|
| Rate for Payer: OMNI Networks Commercial |
$10,333.40
|
| Rate for Payer: One Health Plan PPO/POS |
$13,285.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,023.90
|
| Rate for Payer: Three Rivers Provider Network All |
$11,071.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,728.66
|
| Rate for Payer: Zelis Auto |
$5,904.80
|
|
