|
IMPLT SCREW CANCELLOUS 4.0X12MM
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$176.40
|
| 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 |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$264.60
|
| Rate for Payer: Humana ChoiceCare |
$76.44
|
| Rate for Payer: Multiplan All |
$267.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$176.40
|
| 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: TriWest Veterans Administration/VAPC3 |
$258.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$273.42
|
| Rate for Payer: Zelis Auto |
$117.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$147.00
|
|
|
IMPLT SCREW CANCELLOUS 4.0X12MM
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000769
|
|
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 4.0X12MM
|
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
|
|
|
IMPLT SCREW CANCELLOUS 4.0X14MM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$214.40
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$187.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: Zelis Auto |
$107.20
|
|
|
IMPLT SCREW CANCELLOUS 4.0X14MM
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.80
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$168.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
|
|
IMPLT SCREW CANCELLOUS 4.0X14MM
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Humana ChoiceCare |
$62.66
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.60
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0X14MM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$214.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Humana ChoiceCare |
$69.68
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$160.80
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$235.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$134.00
|
|
|
IMPLT SCREW CANCELLOUS 4.0X16MM
|
Facility
|
OP
|
$1,411.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.75 |
| Max. Negotiated Rate |
$1,340.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$846.60
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,269.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,269.90
|
| Rate for Payer: GEHA Commercial |
$1,128.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,269.90
|
| Rate for Payer: Humana ChoiceCare |
$366.86
|
| Rate for Payer: Multiplan All |
$1,284.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$846.60
|
| Rate for Payer: OMNI Networks Commercial |
$987.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,269.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,340.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,058.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,241.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$352.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,312.23
|
| Rate for Payer: Zelis Auto |
$564.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$705.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0X16MM
|
Facility
|
IP
|
$1,411.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.40 |
| Max. Negotiated Rate |
$1,340.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,128.80
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,269.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,269.90
|
| Rate for Payer: GEHA Commercial |
$987.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,269.90
|
| Rate for Payer: Multiplan All |
$1,284.01
|
| Rate for Payer: OMNI Networks Commercial |
$987.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,269.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,340.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,058.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,312.23
|
| Rate for Payer: Zelis Auto |
$564.40
|
|
|
IMPLT SCREW CANCELLOUS 4.0X16MM
|
Facility
|
OP
|
$6,395.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,598.75 |
| Max. Negotiated Rate |
$6,075.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,837.00
|
| Rate for Payer: Cash Price |
$3,837.00
|
| Rate for Payer: Cash Price |
$3,837.00
|
| Rate for Payer: Cigna Commercial |
$5,435.75
|
| Rate for Payer: First Health Commercial |
$5,755.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,755.50
|
| Rate for Payer: GEHA Commercial |
$5,116.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,755.50
|
| Rate for Payer: Humana ChoiceCare |
$1,662.70
|
| Rate for Payer: Multiplan All |
$5,819.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,837.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,476.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,755.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,075.25
|
| Rate for Payer: Three Rivers Provider Network All |
$4,796.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,627.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,598.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,947.35
|
| Rate for Payer: Zelis Auto |
$2,558.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,197.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0X16MM
|
Facility
|
IP
|
$6,395.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,558.00 |
| Max. Negotiated Rate |
$6,075.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,116.00
|
| Rate for Payer: Cash Price |
$3,837.00
|
| Rate for Payer: Cash Price |
$3,837.00
|
| Rate for Payer: Cigna Commercial |
$5,435.75
|
| Rate for Payer: First Health Commercial |
$5,755.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,755.50
|
| Rate for Payer: GEHA Commercial |
$4,476.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,755.50
|
| Rate for Payer: Multiplan All |
$5,819.45
|
| Rate for Payer: OMNI Networks Commercial |
$4,476.50
|
| Rate for Payer: One Health Plan PPO/POS |
$5,755.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,075.25
|
| Rate for Payer: Three Rivers Provider Network All |
$4,796.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,947.35
|
| Rate for Payer: Zelis Auto |
$2,558.00
|
|
|
IMPLT SCREW,CANCELLOUS 4.0X16MM
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.80
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$168.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
|
|
IMPLT SCREW,CANCELLOUS 4.0X16MM
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Humana ChoiceCare |
$62.66
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.60
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0X18MM
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001373
|
|
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 4.0X18MM
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001373
|
|
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 4.0X18MM
|
Facility
|
OP
|
$1,411.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.75 |
| Max. Negotiated Rate |
$1,340.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$846.60
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,269.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,269.90
|
| Rate for Payer: GEHA Commercial |
$1,128.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,269.90
|
| Rate for Payer: Humana ChoiceCare |
$366.86
|
| Rate for Payer: Multiplan All |
$1,284.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$846.60
|
| Rate for Payer: OMNI Networks Commercial |
$987.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,269.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,340.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,058.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,241.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$352.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,312.23
|
| Rate for Payer: Zelis Auto |
$564.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$705.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0X18MM
|
Facility
|
IP
|
$1,411.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.40 |
| Max. Negotiated Rate |
$1,340.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,128.80
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cash Price |
$846.60
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,269.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,269.90
|
| Rate for Payer: GEHA Commercial |
$987.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,269.90
|
| Rate for Payer: Multiplan All |
$1,284.01
|
| Rate for Payer: OMNI Networks Commercial |
$987.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,269.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,340.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,058.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,312.23
|
| Rate for Payer: Zelis Auto |
$564.40
|
|
|
IMPLT SCREW CANCELLOUS 4.0X20MM
|
Facility
|
IP
|
$2,337.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.80 |
| Max. Negotiated Rate |
$2,220.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,869.60
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cigna Commercial |
$1,986.45
|
| Rate for Payer: First Health Commercial |
$2,103.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,103.30
|
| Rate for Payer: GEHA Commercial |
$1,635.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,103.30
|
| Rate for Payer: Multiplan All |
$2,126.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,635.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,103.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,220.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,752.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,173.41
|
| Rate for Payer: Zelis Auto |
$934.80
|
|
|
IMPLT SCREW CANCELLOUS 4.0X20MM
|
Facility
|
OP
|
$2,337.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.25 |
| Max. Negotiated Rate |
$2,220.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cigna Commercial |
$1,986.45
|
| Rate for Payer: First Health Commercial |
$2,103.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,103.30
|
| Rate for Payer: GEHA Commercial |
$1,869.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,103.30
|
| Rate for Payer: Humana ChoiceCare |
$607.62
|
| Rate for Payer: Multiplan All |
$2,126.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,402.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,635.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,103.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,220.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,752.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,056.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$584.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,173.41
|
| Rate for Payer: Zelis Auto |
$934.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,168.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0X24MM
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.80
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$168.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
|
|
IMPLT SCREW CANCELLOUS 4.0X24MM
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Humana ChoiceCare |
$62.66
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.60
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0X26MM
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$233.60
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$204.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: Zelis Auto |
$116.80
|
|
|
IMPLT SCREW CANCELLOUS 4.0X26MM
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$233.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Humana ChoiceCare |
$75.92
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.20
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$256.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.00
|
|
|
IMPLT SCREW CANCELLOUS 4.0X26MM
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.80
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$168.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
|
|
IMPLT SCREW CANCELLOUS 4.0X26MM
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Humana ChoiceCare |
$62.66
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.60
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.50
|
|
