|
IMPLT SCREW CANCELLOUS 6.0X60MM
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.75 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$311.95
|
| Rate for Payer: First Health Commercial |
$330.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$330.30
|
| Rate for Payer: GEHA Commercial |
$293.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$330.30
|
| Rate for Payer: Humana ChoiceCare |
$95.42
|
| Rate for Payer: Multiplan All |
$333.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$220.20
|
| Rate for Payer: OMNI Networks Commercial |
$256.90
|
| Rate for Payer: One Health Plan PPO/POS |
$330.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$348.65
|
| Rate for Payer: Three Rivers Provider Network All |
$275.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$322.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$341.31
|
| Rate for Payer: Zelis Auto |
$146.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.50
|
|
|
IMPLT SCREW CANCELLOUS 6.0X60MM
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.80 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$293.60
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$311.95
|
| Rate for Payer: First Health Commercial |
$330.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$330.30
|
| Rate for Payer: GEHA Commercial |
$256.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$330.30
|
| Rate for Payer: Multiplan All |
$333.97
|
| Rate for Payer: OMNI Networks Commercial |
$256.90
|
| Rate for Payer: One Health Plan PPO/POS |
$330.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$348.65
|
| Rate for Payer: Three Rivers Provider Network All |
$275.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$341.31
|
| Rate for Payer: Zelis Auto |
$146.80
|
|
|
IMPLT SCREW CANCELLOUS 6.0X65MM
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$298.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Humana ChoiceCare |
$96.98
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$223.80
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$328.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$93.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$186.50
|
|
|
IMPLT SCREW CANCELLOUS 6.0X65MM
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.40
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$261.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
|
|
IMPLT SCREW CANCELLOUS 6.0X70MM
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$298.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Humana ChoiceCare |
$96.98
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$223.80
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$328.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$93.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$186.50
|
|
|
IMPLT SCREW CANCELLOUS 6.0X70MM
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.40
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$261.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
|
|
IMPLT SCREW CANCELLOUS 6.0X75MM
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.40
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$261.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
|
|
IMPLT SCREW CANCELLOUS 6.0X75MM
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$298.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Humana ChoiceCare |
$96.98
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$223.80
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$328.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$93.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$186.50
|
|
|
IMPLT SCREW CANCELLOUS 65MM
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003391
|
|
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 65MM
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003391
|
|
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 6.5MM
|
Facility
|
OP
|
$2,332.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.00 |
| Max. Negotiated Rate |
$2,215.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cigna Commercial |
$1,982.20
|
| Rate for Payer: First Health Commercial |
$2,098.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,098.80
|
| Rate for Payer: GEHA Commercial |
$1,865.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,098.80
|
| Rate for Payer: Humana ChoiceCare |
$606.32
|
| Rate for Payer: Multiplan All |
$2,122.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,399.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,632.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,098.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,215.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,749.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,052.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$583.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,168.76
|
| Rate for Payer: Zelis Auto |
$932.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,166.00
|
|
|
IMPLT SCREW CANCELLOUS 6.5MM
|
Facility
|
IP
|
$2,332.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.80 |
| Max. Negotiated Rate |
$2,215.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,865.60
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cigna Commercial |
$1,982.20
|
| Rate for Payer: First Health Commercial |
$2,098.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,098.80
|
| Rate for Payer: GEHA Commercial |
$1,632.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,098.80
|
| Rate for Payer: Multiplan All |
$2,122.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,632.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,098.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,215.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,749.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,168.76
|
| Rate for Payer: Zelis Auto |
$932.80
|
|
|
IMPLT SCREW CANCELLOUS 6.5X16MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.60
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
|
|
IMPLT SCREW CANCELLOUS 6.5X16MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$121.42
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$280.20
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$410.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.50
|
|
|
IMPLT SCREW CANCELLOUS 6.5X30MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$121.42
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$280.20
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$410.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.50
|
|
|
IMPLT SCREW CANCELLOUS 6.5X30MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.60
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
|
|
IMPLT SCREW CANCELLOUS 6.5X35MM
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000228
|
|
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 6.5X35MM
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000228
|
|
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 6.5X50MM
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000505
|
|
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 6.5X50MM
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000504
|
|
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
|
|
|
IMPLT SCREW CANCELLOUS 6.5X50MM
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000504
|
|
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 6.5X50MM
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000505
|
|
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 6.5X55MM
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002852
|
|
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 6.5X55MM
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002852
|
|
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 6.5X60MM
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002480
|
|
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
|
|
