|
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
|
|
|
IMPLT SCREW CANCELLOUS 4.0X45MM
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.20
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$69.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: Zelis Auto |
$39.60
|
|
|
IMPLT SCREW CANCELLOUS 4.0X45MM
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$79.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Humana ChoiceCare |
$25.74
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.40
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$87.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: Zelis Auto |
$39.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$49.50
|
|
|
IMPLT SCREW,CANCELLOUS 4.0X45MM
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000771
|
|
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 4.0X45MM
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000771
|
|
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 4.0X50MM
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001395
|
|
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 4.0X50MM
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000501
|
|
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 4.0X50MM
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000501
|
|
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 4.0X50MM
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001395
|
|
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 4.0X50MM
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$192.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Humana ChoiceCare |
$62.40
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.00
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$211.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.00
|
|
|
IMPLT SCREW CANCELLOUS 4.0X50MM
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001382
|
|
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 4.0X50MM
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001382
|
|
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 4.0X50MM
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
|
|
IMPLT SCREW CANCELLOUS 4.0X50MM
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$300.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Humana ChoiceCare |
$97.76
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$225.60
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$330.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$188.00
|
|
|
IMPLT SCREW CANCELLOUS 4.0X50MM
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.40 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.80
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
|
|
IMPLT SCREW CANCELLOUS 4.0X55MM
|
Facility
|
OP
|
$2,929.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.25 |
| Max. Negotiated Rate |
$2,782.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,757.40
|
| Rate for Payer: Cash Price |
$1,757.40
|
| Rate for Payer: Cash Price |
$1,757.40
|
| Rate for Payer: Cigna Commercial |
$2,489.65
|
| Rate for Payer: First Health Commercial |
$2,636.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,636.10
|
| Rate for Payer: GEHA Commercial |
$2,343.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,636.10
|
| Rate for Payer: Humana ChoiceCare |
$761.54
|
| Rate for Payer: Multiplan All |
$2,665.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,757.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,050.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,636.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,782.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,196.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,577.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$732.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,723.97
|
| Rate for Payer: Zelis Auto |
$1,171.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,464.50
|
|
|
IMPLT SCREW CANCELLOUS 4.0X55MM
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001383
|
|
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 4.0X55MM
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001383
|
|
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 4.0X55MM
|
Facility
|
IP
|
$2,929.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,171.60 |
| Max. Negotiated Rate |
$2,782.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,343.20
|
| Rate for Payer: Cash Price |
$1,757.40
|
| Rate for Payer: Cash Price |
$1,757.40
|
| Rate for Payer: Cigna Commercial |
$2,489.65
|
| Rate for Payer: First Health Commercial |
$2,636.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,636.10
|
| Rate for Payer: GEHA Commercial |
$2,050.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,636.10
|
| Rate for Payer: Multiplan All |
$2,665.39
|
| Rate for Payer: OMNI Networks Commercial |
$2,050.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,636.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,782.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,196.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,723.97
|
| Rate for Payer: Zelis Auto |
$1,171.60
|
|
|
IMPLT SCREW CANCELLOUS 4.0X60MM
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.60 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$483.20
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$422.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
|
|
IMPLT SCREW CANCELLOUS 4.0X60MM
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$513.40
|
| Rate for Payer: First Health Commercial |
$543.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$543.60
|
| Rate for Payer: GEHA Commercial |
$483.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$543.60
|
| Rate for Payer: Humana ChoiceCare |
$157.04
|
| Rate for Payer: Multiplan All |
$549.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$362.40
|
| Rate for Payer: OMNI Networks Commercial |
$422.80
|
| Rate for Payer: One Health Plan PPO/POS |
$543.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$573.80
|
| Rate for Payer: Three Rivers Provider Network All |
$453.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$531.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$561.72
|
| Rate for Payer: Zelis Auto |
$241.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.00
|
|
|
IMPLT SCREW CANCELLOUS 45MM
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002484
|
|
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 45MM
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002484
|
|
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 4.5X80MM
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$278.80
|
| Rate for Payer: First Health Commercial |
$295.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$295.20
|
| Rate for Payer: GEHA Commercial |
$262.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$295.20
|
| Rate for Payer: Humana ChoiceCare |
$85.28
|
| Rate for Payer: Multiplan All |
$298.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$196.80
|
| Rate for Payer: OMNI Networks Commercial |
$229.60
|
| Rate for Payer: One Health Plan PPO/POS |
$295.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$311.60
|
| Rate for Payer: Three Rivers Provider Network All |
$246.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$288.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$82.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.04
|
| Rate for Payer: Zelis Auto |
$131.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$164.00
|
|
|
IMPLT SCREW CANCELLOUS 4.5X80MM
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$262.40
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$278.80
|
| Rate for Payer: First Health Commercial |
$295.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$295.20
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$295.20
|
| Rate for Payer: Multiplan All |
$298.48
|
| Rate for Payer: OMNI Networks Commercial |
$229.60
|
| Rate for Payer: One Health Plan PPO/POS |
$295.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$311.60
|
| Rate for Payer: Three Rivers Provider Network All |
$246.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.04
|
| Rate for Payer: Zelis Auto |
$131.20
|
|
