|
IMPLT SCREW CAN 9X30MM
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000793
|
|
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 9X30MM
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000793
|
|
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 CANCELLOUS 20MM
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$273.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| Rate for Payer: Humana ChoiceCare |
$88.92
|
| Rate for Payer: Multiplan All |
$311.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$205.20
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$324.90
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$300.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$85.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.06
|
| Rate for Payer: Zelis Auto |
$136.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$171.00
|
|
|
IMPLT SCREW CANCELLOUS 20MM
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$273.60
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$239.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| Rate for Payer: Multiplan All |
$311.22
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$324.90
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.06
|
| Rate for Payer: Zelis Auto |
$136.80
|
|
|
IMPLT SCREW CANCELLOUS 2.7 X12MM
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$276.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$241.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
|
|
IMPLT SCREW CANCELLOUS 2.7 X12MM
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$276.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$89.70
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$207.00
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$303.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$172.50
|
|
|
IMPLT SCREW CANCELLOUS 2.7 X 20MM
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$338.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$284.80
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cigna Commercial |
$302.60
|
| Rate for Payer: First Health Commercial |
$320.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$320.40
|
| Rate for Payer: GEHA Commercial |
$249.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$320.40
|
| Rate for Payer: Multiplan All |
$323.96
|
| Rate for Payer: OMNI Networks Commercial |
$249.20
|
| Rate for Payer: One Health Plan PPO/POS |
$320.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$338.20
|
| Rate for Payer: Three Rivers Provider Network All |
$267.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$331.08
|
| Rate for Payer: Zelis Auto |
$142.40
|
|
|
IMPLT SCREW CANCELLOUS 2.7 X 20MM
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$338.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cigna Commercial |
$302.60
|
| Rate for Payer: First Health Commercial |
$320.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$320.40
|
| Rate for Payer: GEHA Commercial |
$284.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$320.40
|
| Rate for Payer: Humana ChoiceCare |
$92.56
|
| Rate for Payer: Multiplan All |
$323.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$213.60
|
| Rate for Payer: OMNI Networks Commercial |
$249.20
|
| Rate for Payer: One Health Plan PPO/POS |
$320.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$338.20
|
| Rate for Payer: Three Rivers Provider Network All |
$267.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$313.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$331.08
|
| Rate for Payer: Zelis Auto |
$142.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.00
|
|
|
IMPLT SCREW CANCELLOUS 3.5MM
|
Facility
|
OP
|
$2,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.50 |
| Max. Negotiated Rate |
$2,088.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,318.80
|
| Rate for Payer: Cash Price |
$1,318.80
|
| Rate for Payer: Cash Price |
$1,318.80
|
| Rate for Payer: Cigna Commercial |
$1,868.30
|
| Rate for Payer: First Health Commercial |
$1,978.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,978.20
|
| Rate for Payer: GEHA Commercial |
$1,758.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,978.20
|
| Rate for Payer: Humana ChoiceCare |
$571.48
|
| Rate for Payer: Multiplan All |
$2,000.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,318.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,538.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,978.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,088.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,648.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,934.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$549.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,044.14
|
| Rate for Payer: Zelis Auto |
$879.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,099.00
|
|
|
IMPLT SCREW CANCELLOUS 3.5MM
|
Facility
|
IP
|
$2,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.20 |
| Max. Negotiated Rate |
$2,088.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,758.40
|
| Rate for Payer: Cash Price |
$1,318.80
|
| Rate for Payer: Cash Price |
$1,318.80
|
| Rate for Payer: Cigna Commercial |
$1,868.30
|
| Rate for Payer: First Health Commercial |
$1,978.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,978.20
|
| Rate for Payer: GEHA Commercial |
$1,538.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,978.20
|
| Rate for Payer: Multiplan All |
$2,000.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,538.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,978.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,088.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,648.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,044.14
|
| Rate for Payer: Zelis Auto |
$879.20
|
|
|
IMPLT SCREW CANCELLOUS 40MM
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.75 |
| Max. Negotiated Rate |
$732.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$655.35
|
| Rate for Payer: First Health Commercial |
$693.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.90
|
| Rate for Payer: GEHA Commercial |
$616.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.90
|
| Rate for Payer: Humana ChoiceCare |
$200.46
|
| Rate for Payer: Multiplan All |
$701.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$462.60
|
| Rate for Payer: OMNI Networks Commercial |
$539.70
|
| Rate for Payer: One Health Plan PPO/POS |
$693.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$732.45
|
| Rate for Payer: Three Rivers Provider Network All |
$578.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$678.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$192.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$717.03
|
| Rate for Payer: Zelis Auto |
$308.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$385.50
|
|
|
IMPLT SCREW CANCELLOUS 40MM
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$308.40 |
| Max. Negotiated Rate |
$732.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$616.80
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$655.35
|
| Rate for Payer: First Health Commercial |
$693.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.90
|
| Rate for Payer: GEHA Commercial |
$539.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.90
|
| Rate for Payer: Multiplan All |
$701.61
|
| Rate for Payer: OMNI Networks Commercial |
$539.70
|
| Rate for Payer: One Health Plan PPO/POS |
$693.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$732.45
|
| Rate for Payer: Three Rivers Provider Network All |
$578.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$717.03
|
| Rate for Payer: Zelis Auto |
$308.40
|
|
|
IMPLT SCREW CANCELLOUS 4.0MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
|
|
IMPLT SCREW CANCELLOUS 4.0MM
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.25 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$676.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Humana ChoiceCare |
$219.70
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$507.00
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$743.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$211.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$422.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.40
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
|
|
IMPLT SCREW CANCELLOUS 4.0MM
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$676.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$591.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
|
|
IMPLT SCREW CANCELLOUS 4.0MM 207.012
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.20
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$132.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: Zelis Auto |
$75.60
|
|
|
IMPLT SCREW CANCELLOUS 4.0MM 207.012
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$151.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| Rate for Payer: Humana ChoiceCare |
$49.14
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$113.40
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$166.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: Zelis Auto |
$75.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$94.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0MM 207.014
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$176.80
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$154.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: Zelis Auto |
$88.40
|
|
|
IMPLT SCREW CANCELLOUS 4.0MM 207.014
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$176.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Humana ChoiceCare |
$57.46
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$132.60
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$194.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: Zelis Auto |
$88.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$110.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0MM 207.016
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$176.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Humana ChoiceCare |
$57.46
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$132.60
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$194.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: Zelis Auto |
$88.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$110.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0MM 207.016
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$176.80
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$154.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: Zelis Auto |
$88.40
|
|
|
IMPLT SCREW CANCELLOUS 4.0X10MM
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$191.20
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$167.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
|
|
IMPLT SCREW CANCELLOUS 4.0X10MM
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.75 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$191.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Humana ChoiceCare |
$62.14
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$143.40
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$210.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$119.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0X12MM
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.20
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$249.90
|
| Rate for Payer: First Health Commercial |
$264.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$264.60
|
| Rate for Payer: GEHA Commercial |
$205.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$264.60
|
| Rate for Payer: Multiplan All |
$267.54
|
| Rate for Payer: OMNI Networks Commercial |
$205.80
|
| Rate for Payer: One Health Plan PPO/POS |
$264.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$279.30
|
| Rate for Payer: Three Rivers Provider Network All |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$273.42
|
| Rate for Payer: Zelis Auto |
$117.60
|
|
