|
IMPLT SCREW CANCELLOUS 4.0X28MM
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001376
|
|
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 4.0X28MM
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001376
|
|
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,4.0X28MM
|
Facility
|
IP
|
$4,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.60 |
| Max. Negotiated Rate |
$3,870.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,259.20
|
| Rate for Payer: Cash Price |
$2,444.40
|
| Rate for Payer: Cash Price |
$2,444.40
|
| Rate for Payer: Cigna Commercial |
$3,462.90
|
| Rate for Payer: First Health Commercial |
$3,666.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,666.60
|
| Rate for Payer: GEHA Commercial |
$2,851.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,666.60
|
| Rate for Payer: Multiplan All |
$3,707.34
|
| Rate for Payer: OMNI Networks Commercial |
$2,851.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,666.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,870.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,055.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,788.82
|
| Rate for Payer: Zelis Auto |
$1,629.60
|
|
|
IMPLT SCREW, CANCELLOUS,4.0X28MM
|
Facility
|
OP
|
$4,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.50 |
| Max. Negotiated Rate |
$3,870.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,444.40
|
| Rate for Payer: Cash Price |
$2,444.40
|
| Rate for Payer: Cash Price |
$2,444.40
|
| Rate for Payer: Cigna Commercial |
$3,462.90
|
| Rate for Payer: First Health Commercial |
$3,666.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,666.60
|
| Rate for Payer: GEHA Commercial |
$3,259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,666.60
|
| Rate for Payer: Humana ChoiceCare |
$1,059.24
|
| Rate for Payer: Multiplan All |
$3,707.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,444.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,851.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,666.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,870.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,055.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,585.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,018.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,788.82
|
| Rate for Payer: Zelis Auto |
$1,629.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,037.00
|
|
|
IMPLT SCREW CANCELLOUS 4.0X30MM
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001377
|
|
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 4.0X30MM
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000781
|
|
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 4.0X30MM
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001377
|
|
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 4.0X30MM
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000781
|
|
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 4.0X30MM
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001390
|
|
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 4.0X30MM
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001390
|
|
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 4.0X34MM
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001391
|
|
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 4.0X34MM
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001391
|
|
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 4.0X35MM
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001392
|
|
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 4.0X35MM
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001378
|
|
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 4.0X35MM
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001378
|
|
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 4.0X35MM
|
Facility
|
OP
|
$1,841.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.25 |
| Max. Negotiated Rate |
$1,748.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,104.60
|
| Rate for Payer: Cash Price |
$1,104.60
|
| Rate for Payer: Cash Price |
$1,104.60
|
| Rate for Payer: Cigna Commercial |
$1,564.85
|
| Rate for Payer: First Health Commercial |
$1,656.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,656.90
|
| Rate for Payer: GEHA Commercial |
$1,472.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,656.90
|
| Rate for Payer: Humana ChoiceCare |
$478.66
|
| Rate for Payer: Multiplan All |
$1,675.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,104.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,288.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,656.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,748.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,380.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,620.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$460.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,712.13
|
| Rate for Payer: Zelis Auto |
$736.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$920.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0X35MM
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001392
|
|
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 4.0X35MM
|
Facility
|
IP
|
$1,841.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$736.40 |
| Max. Negotiated Rate |
$1,748.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,472.80
|
| Rate for Payer: Cash Price |
$1,104.60
|
| Rate for Payer: Cash Price |
$1,104.60
|
| Rate for Payer: Cigna Commercial |
$1,564.85
|
| Rate for Payer: First Health Commercial |
$1,656.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,656.90
|
| Rate for Payer: GEHA Commercial |
$1,288.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,656.90
|
| Rate for Payer: Multiplan All |
$1,675.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,288.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,656.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,748.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,380.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,712.13
|
| Rate for Payer: Zelis Auto |
$736.40
|
|
|
IMPLT SCREW CANCELLOUS 4.0X36MM
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$185.60
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
|
|
IMPLT SCREW CANCELLOUS 4.0X36MM
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$185.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Humana ChoiceCare |
$60.32
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$139.20
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$204.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$58.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$116.00
|
|
|
IMPLT SCREW CANCELLOUS 4.0X40MM
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001394
|
|
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 4.0X40MM
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.40
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
|
|
IMPLT SCREW CANCELLOUS 4.0X40MM
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001394
|
|
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 4.0X40MM
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001393
|
|
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 4.0X40MM
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001393
|
|
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
|
|
