|
IMPLT SCREW 16MM LOCKING 482801602
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.25 |
| Max. Negotiated Rate |
$624.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$394.20
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cigna Commercial |
$558.45
|
| Rate for Payer: First Health Commercial |
$591.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$591.30
|
| Rate for Payer: GEHA Commercial |
$525.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$591.30
|
| Rate for Payer: Humana ChoiceCare |
$170.82
|
| Rate for Payer: Multiplan All |
$597.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$394.20
|
| Rate for Payer: OMNI Networks Commercial |
$459.90
|
| Rate for Payer: One Health Plan PPO/POS |
$591.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$624.15
|
| Rate for Payer: Three Rivers Provider Network All |
$492.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$578.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$164.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$611.01
|
| Rate for Payer: Zelis Auto |
$262.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$328.50
|
|
|
IMPLT SCREW 16MM LOCKING 482801602
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$624.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$525.60
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cigna Commercial |
$558.45
|
| Rate for Payer: First Health Commercial |
$591.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$591.30
|
| Rate for Payer: GEHA Commercial |
$459.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$591.30
|
| Rate for Payer: Multiplan All |
$597.87
|
| Rate for Payer: OMNI Networks Commercial |
$459.90
|
| Rate for Payer: One Health Plan PPO/POS |
$591.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$624.15
|
| Rate for Payer: Three Rivers Provider Network All |
$492.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$611.01
|
| Rate for Payer: Zelis Auto |
$262.80
|
|
|
IMPLT SCREW 16MM X 20MM
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.25 |
| Max. Negotiated Rate |
$1,285.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$1,150.05
|
| Rate for Payer: First Health Commercial |
$1,217.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,217.70
|
| Rate for Payer: GEHA Commercial |
$1,082.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,217.70
|
| Rate for Payer: Humana ChoiceCare |
$351.78
|
| Rate for Payer: Multiplan All |
$1,231.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$811.80
|
| Rate for Payer: OMNI Networks Commercial |
$947.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,217.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,285.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,190.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$338.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,258.29
|
| Rate for Payer: Zelis Auto |
$541.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$676.50
|
|
|
IMPLT SCREW 16MM X 20MM
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,285.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,082.40
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$1,150.05
|
| Rate for Payer: First Health Commercial |
$1,217.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,217.70
|
| Rate for Payer: GEHA Commercial |
$947.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,217.70
|
| Rate for Payer: Multiplan All |
$1,231.23
|
| Rate for Payer: OMNI Networks Commercial |
$947.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,217.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,285.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,258.29
|
| Rate for Payer: Zelis Auto |
$541.20
|
|
|
IMPLT SCREW 18.0MM ACUTRAK BONE
|
Facility
|
IP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.60 |
| Max. Negotiated Rate |
$2,250.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,895.20
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cigna Commercial |
$2,013.65
|
| Rate for Payer: First Health Commercial |
$2,132.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,132.10
|
| Rate for Payer: GEHA Commercial |
$1,658.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,132.10
|
| Rate for Payer: Multiplan All |
$2,155.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,658.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,132.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,250.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,776.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,203.17
|
| Rate for Payer: Zelis Auto |
$947.60
|
|
|
IMPLT SCREW 18.0MM ACUTRAK BONE
|
Facility
|
OP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.25 |
| Max. Negotiated Rate |
$2,250.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cigna Commercial |
$2,013.65
|
| Rate for Payer: First Health Commercial |
$2,132.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,132.10
|
| Rate for Payer: GEHA Commercial |
$1,895.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,132.10
|
| Rate for Payer: Humana ChoiceCare |
$615.94
|
| Rate for Payer: Multiplan All |
$2,155.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,421.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,658.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,132.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,250.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,776.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,084.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$592.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,203.17
|
| Rate for Payer: Zelis Auto |
$947.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,184.50
|
|
|
IMPLT SCREW 18MM LOCKING
|
Facility
|
IP
|
$1,248.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$1,185.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$998.40
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$1,060.80
|
| Rate for Payer: First Health Commercial |
$1,123.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,123.20
|
| Rate for Payer: GEHA Commercial |
$873.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,123.20
|
| Rate for Payer: Multiplan All |
$1,135.68
|
| Rate for Payer: OMNI Networks Commercial |
$873.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,123.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,185.60
|
| Rate for Payer: Three Rivers Provider Network All |
$936.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,160.64
|
| Rate for Payer: Zelis Auto |
$499.20
|
|
|
IMPLT SCREW 18MM LOCKING
|
Facility
|
OP
|
$1,248.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$1,185.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$1,060.80
|
| Rate for Payer: First Health Commercial |
$1,123.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,123.20
|
| Rate for Payer: GEHA Commercial |
$998.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,123.20
|
| Rate for Payer: Humana ChoiceCare |
$324.48
|
| Rate for Payer: Multiplan All |
$1,135.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$748.80
|
| Rate for Payer: OMNI Networks Commercial |
$873.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,123.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,185.60
|
| Rate for Payer: Three Rivers Provider Network All |
$936.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,098.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$312.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,160.64
|
| Rate for Payer: Zelis Auto |
$499.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$624.00
|
|
|
IMPLT SCREW 18MM LOCKING
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.50 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$433.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Humana ChoiceCare |
$140.92
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$325.20
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$476.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$271.00
|
|
|
IMPLT SCREW 18MM LOCKING
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.80 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$433.60
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$379.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
|
|
IMPLT SCREW 2.0MM 401.594E
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$483.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Humana ChoiceCare |
$157.04
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$362.40
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$531.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.00
|
|
|
IMPLT SCREW 2.0MM 401.594E
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.60 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$483.20
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$422.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
|
|
IMPLT SCREW 2.0MM 401.598E
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$173.75 |
| Max. Negotiated Rate |
$660.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$590.75
|
| Rate for Payer: First Health Commercial |
$625.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$625.50
|
| Rate for Payer: GEHA Commercial |
$556.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$625.50
|
| Rate for Payer: Humana ChoiceCare |
$180.70
|
| Rate for Payer: Multiplan All |
$632.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$417.00
|
| Rate for Payer: OMNI Networks Commercial |
$486.50
|
| Rate for Payer: One Health Plan PPO/POS |
$625.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$660.25
|
| Rate for Payer: Three Rivers Provider Network All |
$521.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$611.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$173.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$646.35
|
| Rate for Payer: Zelis Auto |
$278.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$347.50
|
|
|
IMPLT SCREW 2.0MM 401.598E
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$660.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$590.75
|
| Rate for Payer: First Health Commercial |
$625.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$625.50
|
| Rate for Payer: GEHA Commercial |
$486.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$625.50
|
| Rate for Payer: Multiplan All |
$632.45
|
| Rate for Payer: OMNI Networks Commercial |
$486.50
|
| Rate for Payer: One Health Plan PPO/POS |
$625.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$660.25
|
| Rate for Payer: Three Rivers Provider Network All |
$521.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$646.35
|
| Rate for Payer: Zelis Auto |
$278.00
|
|
|
IMPLT SCREW 2.0MM X 20MM
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,285.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,082.40
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$1,150.05
|
| Rate for Payer: First Health Commercial |
$1,217.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,217.70
|
| Rate for Payer: GEHA Commercial |
$947.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,217.70
|
| Rate for Payer: Multiplan All |
$1,231.23
|
| Rate for Payer: OMNI Networks Commercial |
$947.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,217.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,285.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,258.29
|
| Rate for Payer: Zelis Auto |
$541.20
|
|
|
IMPLT SCREW 2.0MM X 20MM
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.25 |
| Max. Negotiated Rate |
$1,285.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$1,150.05
|
| Rate for Payer: First Health Commercial |
$1,217.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,217.70
|
| Rate for Payer: GEHA Commercial |
$1,082.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,217.70
|
| Rate for Payer: Humana ChoiceCare |
$351.78
|
| Rate for Payer: Multiplan All |
$1,231.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$811.80
|
| Rate for Payer: OMNI Networks Commercial |
$947.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,217.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,285.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,190.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$338.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,258.29
|
| Rate for Payer: Zelis Auto |
$541.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$676.50
|
|
|
IMPLT SCREW 2.3MM 12MM
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Humana ChoiceCare |
$164.32
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$379.20
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$556.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$158.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$316.00
|
|
|
IMPLT SCREW 2.3MM 12MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.60
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$442.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
|
|
IMPLT SCREW 2.3 SUTURE PASSER
|
Facility
|
IP
|
$1,131.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.40 |
| Max. Negotiated Rate |
$1,074.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$904.80
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$961.35
|
| Rate for Payer: First Health Commercial |
$1,017.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,017.90
|
| Rate for Payer: GEHA Commercial |
$791.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,017.90
|
| Rate for Payer: Multiplan All |
$1,029.21
|
| Rate for Payer: OMNI Networks Commercial |
$791.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,017.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,074.45
|
| Rate for Payer: Three Rivers Provider Network All |
$848.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,051.83
|
| Rate for Payer: Zelis Auto |
$452.40
|
|
|
IMPLT SCREW 2.3 SUTURE PASSER
|
Facility
|
OP
|
$1,131.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.75 |
| Max. Negotiated Rate |
$1,074.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$961.35
|
| Rate for Payer: First Health Commercial |
$1,017.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,017.90
|
| Rate for Payer: GEHA Commercial |
$904.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,017.90
|
| Rate for Payer: Humana ChoiceCare |
$294.06
|
| Rate for Payer: Multiplan All |
$1,029.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$678.60
|
| Rate for Payer: OMNI Networks Commercial |
$791.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,017.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,074.45
|
| Rate for Payer: Three Rivers Provider Network All |
$848.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$995.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$282.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,051.83
|
| Rate for Payer: Zelis Auto |
$452.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$565.50
|
|
|
IMPLT SCREW 2.3 X 22MM
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Humana ChoiceCare |
$164.32
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$379.20
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$556.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$158.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$316.00
|
|
|
IMPLT SCREW 2.3 X 22MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.60
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$442.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
|
|
IMPLT SCREW 2.4MM 401.510E
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.00 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$771.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Humana ChoiceCare |
$250.64
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$578.40
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$241.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$482.00
|
|
|
IMPLT SCREW 2.4MM 401.510E
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$385.60 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$771.20
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$674.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: Zelis Auto |
$385.60
|
|
|
IMPLT SCREW 2.5 CORTEX 14MM
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$213.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Humana ChoiceCare |
$69.42
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$160.20
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$234.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$133.50
|
|
