|
IMPLT SCREW BONE THREAD FULL 3.5MMX22MM
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$470.40
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$411.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX24MM
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$470.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Humana ChoiceCare |
$152.88
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$352.80
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$517.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$294.00
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX24MM
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$470.40
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$411.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
|
|
IMPLT SCREW CAN 6.5X125MM 22MM PT SS
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.00 |
| Max. Negotiated Rate |
$1,600.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,348.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,432.25
|
| Rate for Payer: First Health Commercial |
$1,516.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,516.50
|
| Rate for Payer: GEHA Commercial |
$1,179.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,516.50
|
| Rate for Payer: Multiplan All |
$1,533.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,179.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,516.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,600.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,263.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,567.05
|
| Rate for Payer: Zelis Auto |
$674.00
|
|
|
IMPLT SCREW CAN 6.5X125MM 22MM PT SS
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.25 |
| Max. Negotiated Rate |
$1,600.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,011.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,432.25
|
| Rate for Payer: First Health Commercial |
$1,516.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,516.50
|
| Rate for Payer: GEHA Commercial |
$1,348.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,516.50
|
| Rate for Payer: Humana ChoiceCare |
$438.10
|
| Rate for Payer: Multiplan All |
$1,533.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,011.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,179.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,516.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,600.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,263.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,482.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$421.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,567.05
|
| Rate for Payer: Zelis Auto |
$674.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$842.50
|
|
|
IMPLT SCREW CAN 6.5X30MM 22MM PT SS
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.25 |
| Max. Negotiated Rate |
$1,600.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,011.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,432.25
|
| Rate for Payer: First Health Commercial |
$1,516.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,516.50
|
| Rate for Payer: GEHA Commercial |
$1,348.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,516.50
|
| Rate for Payer: Humana ChoiceCare |
$438.10
|
| Rate for Payer: Multiplan All |
$1,533.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,011.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,179.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,516.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,600.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,263.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,482.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$421.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,567.05
|
| Rate for Payer: Zelis Auto |
$674.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$842.50
|
|
|
IMPLT SCREW CAN 6.5X30MM 22MM PT SS
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.00 |
| Max. Negotiated Rate |
$1,600.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,348.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,432.25
|
| Rate for Payer: First Health Commercial |
$1,516.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,516.50
|
| Rate for Payer: GEHA Commercial |
$1,179.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,516.50
|
| Rate for Payer: Multiplan All |
$1,533.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,179.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,516.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,600.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,263.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,567.05
|
| Rate for Payer: Zelis Auto |
$674.00
|
|
|
IMPLT SCREW CAN 6X20
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.75 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$692.75
|
| Rate for Payer: First Health Commercial |
$733.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$733.50
|
| Rate for Payer: GEHA Commercial |
$652.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Humana ChoiceCare |
$211.90
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$489.00
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$717.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$203.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: Zelis Auto |
$326.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$407.50
|
|
|
IMPLT SCREW CAN 6X20
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.00 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$652.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$692.75
|
| Rate for Payer: First Health Commercial |
$733.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$733.50
|
| Rate for Payer: GEHA Commercial |
$570.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: Zelis Auto |
$326.00
|
|
|
IMPLT SCREW CAN 6X25
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.50 |
| Max. Negotiated Rate |
$750.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$671.50
|
| Rate for Payer: First Health Commercial |
$711.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$711.00
|
| Rate for Payer: GEHA Commercial |
$632.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$711.00
|
| Rate for Payer: Humana ChoiceCare |
$205.40
|
| Rate for Payer: Multiplan All |
$718.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$474.00
|
| Rate for Payer: OMNI Networks Commercial |
$553.00
|
| Rate for Payer: One Health Plan PPO/POS |
$711.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$750.50
|
| Rate for Payer: Three Rivers Provider Network All |
$592.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$695.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$197.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$734.70
|
| Rate for Payer: Zelis Auto |
$316.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$395.00
|
|
|
IMPLT SCREW CAN 6X25
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$750.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$632.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$671.50
|
| Rate for Payer: First Health Commercial |
$711.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$711.00
|
| Rate for Payer: GEHA Commercial |
$553.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$711.00
|
| Rate for Payer: Multiplan All |
$718.90
|
| Rate for Payer: OMNI Networks Commercial |
$553.00
|
| Rate for Payer: One Health Plan PPO/POS |
$711.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$750.50
|
| Rate for Payer: Three Rivers Provider Network All |
$592.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$734.70
|
| Rate for Payer: Zelis Auto |
$316.00
|
|
|
IMPLT SCREW CAN 6X30
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$750.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$632.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$671.50
|
| Rate for Payer: First Health Commercial |
$711.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$711.00
|
| Rate for Payer: GEHA Commercial |
$553.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$711.00
|
| Rate for Payer: Multiplan All |
$718.90
|
| Rate for Payer: OMNI Networks Commercial |
$553.00
|
| Rate for Payer: One Health Plan PPO/POS |
$711.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$750.50
|
| Rate for Payer: Three Rivers Provider Network All |
$592.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$734.70
|
| Rate for Payer: Zelis Auto |
$316.00
|
|
|
IMPLT SCREW CAN 6X30
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.50 |
| Max. Negotiated Rate |
$750.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$671.50
|
| Rate for Payer: First Health Commercial |
$711.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$711.00
|
| Rate for Payer: GEHA Commercial |
$632.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$711.00
|
| Rate for Payer: Humana ChoiceCare |
$205.40
|
| Rate for Payer: Multiplan All |
$718.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$474.00
|
| Rate for Payer: OMNI Networks Commercial |
$553.00
|
| Rate for Payer: One Health Plan PPO/POS |
$711.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$750.50
|
| Rate for Payer: Three Rivers Provider Network All |
$592.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$695.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$197.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$734.70
|
| Rate for Payer: Zelis Auto |
$316.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$395.00
|
|
|
IMPLT SCREW CAN 7X20MM
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.00 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$652.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$692.75
|
| Rate for Payer: First Health Commercial |
$733.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$733.50
|
| Rate for Payer: GEHA Commercial |
$570.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: Zelis Auto |
$326.00
|
|
|
IMPLT SCREW CAN 7X20MM
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.75 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$692.75
|
| Rate for Payer: First Health Commercial |
$733.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$733.50
|
| Rate for Payer: GEHA Commercial |
$652.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Humana ChoiceCare |
$211.90
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$489.00
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$717.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$203.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: Zelis Auto |
$326.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$407.50
|
|
|
IMPLT SCREW CAN 7X30MM
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.00 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$652.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$692.75
|
| Rate for Payer: First Health Commercial |
$733.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$733.50
|
| Rate for Payer: GEHA Commercial |
$570.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: Zelis Auto |
$326.00
|
|
|
IMPLT SCREW CAN 7X30MM
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.75 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$692.75
|
| Rate for Payer: First Health Commercial |
$733.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$733.50
|
| Rate for Payer: GEHA Commercial |
$652.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Humana ChoiceCare |
$211.90
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$489.00
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$717.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$203.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: Zelis Auto |
$326.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$407.50
|
|
|
IMPLT SCREW CAN 8X20MM
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.75 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$692.75
|
| Rate for Payer: First Health Commercial |
$733.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$733.50
|
| Rate for Payer: GEHA Commercial |
$652.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Humana ChoiceCare |
$211.90
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$489.00
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$717.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$203.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: Zelis Auto |
$326.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$407.50
|
|
|
IMPLT SCREW CAN 8X20MM
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.00 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$652.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$692.75
|
| Rate for Payer: First Health Commercial |
$733.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$733.50
|
| Rate for Payer: GEHA Commercial |
$570.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: Zelis Auto |
$326.00
|
|
|
IMPLT SCREW CAN 8X25MM
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.00 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$652.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$692.75
|
| Rate for Payer: First Health Commercial |
$733.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$733.50
|
| Rate for Payer: GEHA Commercial |
$570.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: Zelis Auto |
$326.00
|
|
|
IMPLT SCREW CAN 8X25MM
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.75 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$692.75
|
| Rate for Payer: First Health Commercial |
$733.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$733.50
|
| Rate for Payer: GEHA Commercial |
$652.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Humana ChoiceCare |
$211.90
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$489.00
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$717.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$203.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: Zelis Auto |
$326.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$407.50
|
|
|
IMPLT SCREW CAN 9X20MM
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.50 |
| Max. Negotiated Rate |
$750.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$671.50
|
| Rate for Payer: First Health Commercial |
$711.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$711.00
|
| Rate for Payer: GEHA Commercial |
$632.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$711.00
|
| Rate for Payer: Humana ChoiceCare |
$205.40
|
| Rate for Payer: Multiplan All |
$718.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$474.00
|
| Rate for Payer: OMNI Networks Commercial |
$553.00
|
| Rate for Payer: One Health Plan PPO/POS |
$711.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$750.50
|
| Rate for Payer: Three Rivers Provider Network All |
$592.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$695.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$197.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$734.70
|
| Rate for Payer: Zelis Auto |
$316.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$395.00
|
|
|
IMPLT SCREW CAN 9X20MM
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$750.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$632.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$671.50
|
| Rate for Payer: First Health Commercial |
$711.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$711.00
|
| Rate for Payer: GEHA Commercial |
$553.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$711.00
|
| Rate for Payer: Multiplan All |
$718.90
|
| Rate for Payer: OMNI Networks Commercial |
$553.00
|
| Rate for Payer: One Health Plan PPO/POS |
$711.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$750.50
|
| Rate for Payer: Three Rivers Provider Network All |
$592.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$734.70
|
| Rate for Payer: Zelis Auto |
$316.00
|
|
|
IMPLT SCREW CAN 9X25MM
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.75 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$692.75
|
| Rate for Payer: First Health Commercial |
$733.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$733.50
|
| Rate for Payer: GEHA Commercial |
$652.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Humana ChoiceCare |
$211.90
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$489.00
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$717.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$203.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: Zelis Auto |
$326.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$407.50
|
|
|
IMPLT SCREW CAN 9X25MM
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.00 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$652.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$692.75
|
| Rate for Payer: First Health Commercial |
$733.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$733.50
|
| Rate for Payer: GEHA Commercial |
$570.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: Zelis Auto |
$326.00
|
|
