|
IMPLT SCREW BONE 1.2X10MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW BONE 1.2X10MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW BONE 1.2X7MM
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$491.20
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$429.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
|
|
IMPLT SCREW BONE 1.2X7MM
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.50 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$491.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Humana ChoiceCare |
$159.64
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$368.40
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$540.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$153.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$307.00
|
|
|
IMPLT SCREW BONE 1.2X9MM
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$491.20
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$429.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
|
|
IMPLT SCREW BONE 1.2X9MM
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.50 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$491.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Humana ChoiceCare |
$159.64
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$368.40
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$540.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$153.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$307.00
|
|
|
IMPLT SCREW BONE 1.7X10MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW BONE 1.7X10MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW BONE 1.7 X 11MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW BONE 1.7 X 11MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW BONE 1.7X13MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW BONE 1.7X13MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW BONE 1.7X14MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW BONE 1.7X14MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW BONE 1.7X16MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW BONE 1.7X16MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW BONE 1.7X18MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW BONE 1.7X18MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW BONE 1.7X8MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW BONE 1.7X8MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW BONE 1.9X12MM
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$189.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Humana ChoiceCare |
$61.62
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.20
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$208.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$118.50
|
|
|
IMPLT SCREW BONE 1.9X12MM
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$189.60
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$165.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
|
|
IMPLT SCREW BONE 2.3MM
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$420.75
|
| Rate for Payer: First Health Commercial |
$445.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.50
|
| Rate for Payer: GEHA Commercial |
$396.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.50
|
| Rate for Payer: Humana ChoiceCare |
$128.70
|
| Rate for Payer: Multiplan All |
$450.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$297.00
|
| Rate for Payer: OMNI Networks Commercial |
$346.50
|
| Rate for Payer: One Health Plan PPO/POS |
$445.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.25
|
| Rate for Payer: Three Rivers Provider Network All |
$371.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$435.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$123.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.35
|
| Rate for Payer: Zelis Auto |
$198.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$247.50
|
|
|
IMPLT SCREW BONE 2.3MM
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$420.75
|
| Rate for Payer: First Health Commercial |
$445.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.50
|
| Rate for Payer: GEHA Commercial |
$346.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.50
|
| Rate for Payer: Multiplan All |
$450.45
|
| Rate for Payer: OMNI Networks Commercial |
$346.50
|
| Rate for Payer: One Health Plan PPO/POS |
$445.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.25
|
| Rate for Payer: Three Rivers Provider Network All |
$371.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.35
|
| Rate for Payer: Zelis Auto |
$198.00
|
|
|
IMPLT SCREW BONE 2.3MM VARIAX
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000761
|
|
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
|
|
