|
IMPLT SCREW BONE 2.3MM VARIAX
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000761
|
|
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 BONE 2.3X10MM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$331.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
|
|
IMPLT SCREW BONE 2.3X10MM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$379.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Humana ChoiceCare |
$123.24
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$284.40
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$417.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$237.00
|
|
|
IMPLT SCREW BONE 2.3X11MM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$331.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
|
|
IMPLT SCREW BONE 2.3X11MM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$379.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Humana ChoiceCare |
$123.24
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$284.40
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$417.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$237.00
|
|
|
IMPLT SCREW BONE 2.3X12MM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$379.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Humana ChoiceCare |
$123.24
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$284.40
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$417.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$237.00
|
|
|
IMPLT SCREW BONE 2.3X12MM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$331.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
|
|
IMPLT SCREW BONE 2.3X13MM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$331.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
|
|
IMPLT SCREW BONE 2.3X13MM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$379.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Humana ChoiceCare |
$123.24
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$284.40
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$417.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$237.00
|
|
|
IMPLT SCREW BONE 2.3X14MM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$379.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Humana ChoiceCare |
$123.24
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$284.40
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$417.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$237.00
|
|
|
IMPLT SCREW BONE 2.3X14MM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$331.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
|
|
IMPLT SCREW BONE 2.3X18MM
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000468
|
|
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 2.3X18MM
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000468
|
|
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 2.3X20MM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000469
|
|
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 BONE 2.3X20MM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000469
|
|
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 BONE 2.3X22MM
|
Facility
|
IP
|
$4,022.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.80 |
| Max. Negotiated Rate |
$3,820.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,217.60
|
| Rate for Payer: Cash Price |
$2,413.20
|
| Rate for Payer: Cash Price |
$2,413.20
|
| Rate for Payer: Cigna Commercial |
$3,418.70
|
| Rate for Payer: First Health Commercial |
$3,619.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,619.80
|
| Rate for Payer: GEHA Commercial |
$2,815.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,619.80
|
| Rate for Payer: Multiplan All |
$3,660.02
|
| Rate for Payer: OMNI Networks Commercial |
$2,815.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,619.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,820.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,016.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,740.46
|
| Rate for Payer: Zelis Auto |
$1,608.80
|
|
|
IMPLT SCREW BONE 2.3X22MM
|
Facility
|
OP
|
$4,022.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.50 |
| Max. Negotiated Rate |
$3,820.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,413.20
|
| Rate for Payer: Cash Price |
$2,413.20
|
| Rate for Payer: Cash Price |
$2,413.20
|
| Rate for Payer: Cigna Commercial |
$3,418.70
|
| Rate for Payer: First Health Commercial |
$3,619.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,619.80
|
| Rate for Payer: GEHA Commercial |
$3,217.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,619.80
|
| Rate for Payer: Humana ChoiceCare |
$1,045.72
|
| Rate for Payer: Multiplan All |
$3,660.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,413.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,815.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,619.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,820.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,016.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,539.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,005.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,740.46
|
| Rate for Payer: Zelis Auto |
$1,608.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,011.00
|
|
|
IMPLT SCREW BONE 2.3X24MM
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006551
|
|
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 BONE 2.3X24MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006551
|
|
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 BONE 2.3X26MM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002989
|
|
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 BONE 2.3X26MM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002989
|
|
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 BONE 2.3X30MM
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003143
|
|
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 BONE 2.3X30MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000471
|
|
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 BONE 2.3X30MM
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000471
|
|
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 BONE 2.3X30MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003143
|
|
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
|
|
