|
IMPLT SCREW 4.0 CANN P/T 20MM
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.80
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
|
|
IMPLT SCREW 4.0 CANN P/T 20MM
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
|
|
IMPLT SCREW 4.0 CANN P/T 22MM
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.80
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
|
|
IMPLT SCREW 4.0 CANN P/T 22MM
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
|
|
IMPLT SCREW 4.0 CANN P/T 24MM
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.80
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
|
|
IMPLT SCREW 4.0 CANN P/T 24MM
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
|
|
IMPLT SCREW 4.0 CANN P/T 30MM
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
|
|
IMPLT SCREW 4.0 CANN P/T 30MM
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.80
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
|
|
IMPLT SCREW 4.0 CANN P/T 35MM
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
|
|
IMPLT SCREW 4.0 CANN P/T 35MM
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.80
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
|
|
IMPLT SCREW 4.0 CANN P/T 45MM
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.80
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
|
|
IMPLT SCREW 4.0 CANN P/T 45MM
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
|
|
IMPLT SCREW 4.0 CANN P/T 50MM
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.80
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
|
|
IMPLT SCREW 4.0 CANN P/T 50MM
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
|
|
IMPLT SCREW 4.0 CANNULATED 20MM
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,305.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,099.20
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$961.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| Rate for Payer: Multiplan All |
$1,250.34
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,305.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,277.82
|
| Rate for Payer: Zelis Auto |
$549.60
|
|
|
IMPLT SCREW 4.0 CANNULATED 20MM
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.50 |
| Max. Negotiated Rate |
$1,305.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$1,099.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| Rate for Payer: Humana ChoiceCare |
$357.24
|
| Rate for Payer: Multiplan All |
$1,250.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$824.40
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,305.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,209.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$343.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,277.82
|
| Rate for Payer: Zelis Auto |
$549.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$687.00
|
|
|
IMPLT SCREW,4.0 CANNULATED 30MM
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$299.50 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$958.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Humana ChoiceCare |
$311.48
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$718.80
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,054.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$299.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$599.00
|
|
|
IMPLT SCREW,4.0 CANNULATED 30MM
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.20 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$958.40
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$838.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
|
|
IMPLT SCREW 4.0 CANNULATED 34MM
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$299.50 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$958.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Humana ChoiceCare |
$311.48
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$718.80
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,054.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$299.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$599.00
|
|
|
IMPLT SCREW 4.0 CANNULATED 34MM
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.20 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$958.40
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$838.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
|
|
IMPLT SCREW 4.0 CANNULATED 36MM
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$299.50 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$958.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Humana ChoiceCare |
$311.48
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$718.80
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,054.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$299.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$599.00
|
|
|
IMPLT SCREW 4.0 CANNULATED 36MM
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.20 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$958.40
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$838.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
|
|
IMPLT SCREW 4.0 CANNULATED 42MM
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.20 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$958.40
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$838.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
|
|
IMPLT SCREW 4.0 CANNULATED 42MM
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$299.50 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$958.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Humana ChoiceCare |
$311.48
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$718.80
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,054.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$299.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$599.00
|
|
|
IMPLT SCREW 4.0 CANNULATED 48MM
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$299.50 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$958.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Humana ChoiceCare |
$311.48
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$718.80
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,054.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$299.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$599.00
|
|
