|
IMPLT SCREW BONE 2.7X24MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000762
|
|
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 2.7X26MM
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001325
|
|
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 2.7X26MM
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.75 |
| Max. Negotiated Rate |
$633.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$566.95
|
| Rate for Payer: First Health Commercial |
$600.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$600.30
|
| Rate for Payer: GEHA Commercial |
$533.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$600.30
|
| Rate for Payer: Humana ChoiceCare |
$173.42
|
| Rate for Payer: Multiplan All |
$606.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$400.20
|
| Rate for Payer: OMNI Networks Commercial |
$466.90
|
| Rate for Payer: One Health Plan PPO/POS |
$600.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$633.65
|
| Rate for Payer: Three Rivers Provider Network All |
$500.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$586.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$166.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$620.31
|
| Rate for Payer: Zelis Auto |
$266.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$333.50
|
|
|
IMPLT SCREW BONE 2.7X26MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001325
|
|
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 2.7X26MM
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$633.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$533.60
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$566.95
|
| Rate for Payer: First Health Commercial |
$600.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$600.30
|
| Rate for Payer: GEHA Commercial |
$466.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$600.30
|
| Rate for Payer: Multiplan All |
$606.97
|
| Rate for Payer: OMNI Networks Commercial |
$466.90
|
| Rate for Payer: One Health Plan PPO/POS |
$600.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$633.65
|
| Rate for Payer: Three Rivers Provider Network All |
$500.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$620.31
|
| Rate for Payer: Zelis Auto |
$266.80
|
|
|
IMPLT SCREW BONE 3.0X34MM
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.60 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$843.20
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$737.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| Rate for Payer: Multiplan All |
$959.14
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,001.30
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$980.22
|
| Rate for Payer: Zelis Auto |
$421.60
|
|
|
IMPLT SCREW BONE 3.0X34MM
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.50 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$843.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| Rate for Payer: Humana ChoiceCare |
$274.04
|
| Rate for Payer: Multiplan All |
$959.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$632.40
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,001.30
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$927.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$980.22
|
| Rate for Payer: Zelis Auto |
$421.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.00
|
|
|
IMPLT SCREW BONE 3.0X36MM
|
Facility
|
IP
|
$2,138.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.20 |
| Max. Negotiated Rate |
$2,031.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,710.40
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cigna Commercial |
$1,817.30
|
| Rate for Payer: First Health Commercial |
$1,924.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,924.20
|
| Rate for Payer: GEHA Commercial |
$1,496.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,924.20
|
| Rate for Payer: Multiplan All |
$1,945.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,496.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,924.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,031.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,603.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,988.34
|
| Rate for Payer: Zelis Auto |
$855.20
|
|
|
IMPLT SCREW BONE 3.0X36MM
|
Facility
|
OP
|
$2,138.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.50 |
| Max. Negotiated Rate |
$2,031.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,282.80
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cigna Commercial |
$1,817.30
|
| Rate for Payer: First Health Commercial |
$1,924.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,924.20
|
| Rate for Payer: GEHA Commercial |
$1,710.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,924.20
|
| Rate for Payer: Humana ChoiceCare |
$555.88
|
| Rate for Payer: Multiplan All |
$1,945.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,282.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,496.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,924.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,031.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,603.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,881.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$534.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,988.34
|
| Rate for Payer: Zelis Auto |
$855.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,069.00
|
|
|
IMPLT SCREW BONE 3.2X18MM
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.80 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,385.60
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,212.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
|
|
IMPLT SCREW BONE 3.2X18MM
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.00 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,385.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Humana ChoiceCare |
$450.32
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,039.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,524.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$433.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$866.00
|
|
|
IMPLT SCREW BONE 3.2X20MM
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.00 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,385.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Humana ChoiceCare |
$450.32
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,039.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,524.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$433.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$866.00
|
|
|
IMPLT SCREW BONE 3.2X20MM
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.80 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,385.60
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,212.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
|
|
IMPLT SCREW BONE 3.2X28MM
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.00 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,385.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Humana ChoiceCare |
$450.32
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,039.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,524.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$433.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$866.00
|
|
|
IMPLT SCREW BONE 3.2X28MM
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.80 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,385.60
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,212.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
|
|
IMPLT SCREW BONE 3.5X10MM
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$390.15
|
| Rate for Payer: First Health Commercial |
$413.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$413.10
|
| Rate for Payer: GEHA Commercial |
$367.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$413.10
|
| Rate for Payer: Humana ChoiceCare |
$119.34
|
| Rate for Payer: Multiplan All |
$417.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$275.40
|
| Rate for Payer: OMNI Networks Commercial |
$321.30
|
| Rate for Payer: One Health Plan PPO/POS |
$413.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$436.05
|
| Rate for Payer: Three Rivers Provider Network All |
$344.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$403.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$426.87
|
| Rate for Payer: Zelis Auto |
$183.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.50
|
|
|
IMPLT SCREW BONE 3.5X10MM
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$367.20
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$390.15
|
| Rate for Payer: First Health Commercial |
$413.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$413.10
|
| Rate for Payer: GEHA Commercial |
$321.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$413.10
|
| Rate for Payer: Multiplan All |
$417.69
|
| Rate for Payer: OMNI Networks Commercial |
$321.30
|
| Rate for Payer: One Health Plan PPO/POS |
$413.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$436.05
|
| Rate for Payer: Three Rivers Provider Network All |
$344.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$426.87
|
| Rate for Payer: Zelis Auto |
$183.60
|
|
|
IMPLT SCREW BONE 3.5X12MM
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$484.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$423.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
|
|
IMPLT SCREW BONE 3.5X12MM
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.25 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$484.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Humana ChoiceCare |
$157.30
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$363.00
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$532.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.50
|
|
|
IMPLT SCREW BONE 3.5X14MM
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$367.20
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$390.15
|
| Rate for Payer: First Health Commercial |
$413.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$413.10
|
| Rate for Payer: GEHA Commercial |
$321.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$413.10
|
| Rate for Payer: Multiplan All |
$417.69
|
| Rate for Payer: OMNI Networks Commercial |
$321.30
|
| Rate for Payer: One Health Plan PPO/POS |
$413.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$436.05
|
| Rate for Payer: Three Rivers Provider Network All |
$344.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$426.87
|
| Rate for Payer: Zelis Auto |
$183.60
|
|
|
IMPLT SCREW BONE 3.5X14MM
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$390.15
|
| Rate for Payer: First Health Commercial |
$413.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$413.10
|
| Rate for Payer: GEHA Commercial |
$367.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$413.10
|
| Rate for Payer: Humana ChoiceCare |
$119.34
|
| Rate for Payer: Multiplan All |
$417.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$275.40
|
| Rate for Payer: OMNI Networks Commercial |
$321.30
|
| Rate for Payer: One Health Plan PPO/POS |
$413.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$436.05
|
| Rate for Payer: Three Rivers Provider Network All |
$344.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$403.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$426.87
|
| Rate for Payer: Zelis Auto |
$183.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.50
|
|
|
IMPLT SCREW BONE 3.5X16MM
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000480
|
|
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 3.5X16MM
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000480
|
|
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 3.5X18MM
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$390.15
|
| Rate for Payer: First Health Commercial |
$413.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$413.10
|
| Rate for Payer: GEHA Commercial |
$367.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$413.10
|
| Rate for Payer: Humana ChoiceCare |
$119.34
|
| Rate for Payer: Multiplan All |
$417.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$275.40
|
| Rate for Payer: OMNI Networks Commercial |
$321.30
|
| Rate for Payer: One Health Plan PPO/POS |
$413.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$436.05
|
| Rate for Payer: Three Rivers Provider Network All |
$344.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$403.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$426.87
|
| Rate for Payer: Zelis Auto |
$183.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.50
|
|
|
IMPLT SCREW BONE 3.5X18MM
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$367.20
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$390.15
|
| Rate for Payer: First Health Commercial |
$413.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$413.10
|
| Rate for Payer: GEHA Commercial |
$321.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$413.10
|
| Rate for Payer: Multiplan All |
$417.69
|
| Rate for Payer: OMNI Networks Commercial |
$321.30
|
| Rate for Payer: One Health Plan PPO/POS |
$413.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$436.05
|
| Rate for Payer: Three Rivers Provider Network All |
$344.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$426.87
|
| Rate for Payer: Zelis Auto |
$183.60
|
|
