|
IMPLT SCREW CANCELLOUS 6.5X60MM
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000506
|
|
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 6.5X60MM
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000506
|
|
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
|
OP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002480
|
|
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 6.5X65MM
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000507
|
|
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 6.5X65MM
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000507
|
|
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 6.5X70MM
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000508
|
|
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 6.5X70MM
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000508
|
|
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 6.5X75MM
|
Facility
|
OP
|
$1,296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,231.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: First Health Commercial |
$1,166.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,166.40
|
| Rate for Payer: GEHA Commercial |
$1,036.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,166.40
|
| Rate for Payer: Humana ChoiceCare |
$336.96
|
| Rate for Payer: Multiplan All |
$1,179.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$777.60
|
| Rate for Payer: OMNI Networks Commercial |
$907.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,166.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,231.20
|
| Rate for Payer: Three Rivers Provider Network All |
$972.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,140.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$324.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,205.28
|
| Rate for Payer: Zelis Auto |
$518.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$648.00
|
|
|
IMPLT SCREW CANCELLOUS 6.5X75MM
|
Facility
|
IP
|
$1,296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.40 |
| Max. Negotiated Rate |
$1,231.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,036.80
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: First Health Commercial |
$1,166.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,166.40
|
| Rate for Payer: GEHA Commercial |
$907.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,166.40
|
| Rate for Payer: Multiplan All |
$1,179.36
|
| Rate for Payer: OMNI Networks Commercial |
$907.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,166.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,231.20
|
| Rate for Payer: Three Rivers Provider Network All |
$972.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,205.28
|
| Rate for Payer: Zelis Auto |
$518.40
|
|
|
IMPLT SCREW CANCELLOUS 6.5X75MM
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000509
|
|
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 6.5X75MM
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000509
|
|
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 6.5X90MM
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.00 |
| Max. Negotiated Rate |
$1,600.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,348.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,432.25
|
| Rate for Payer: First Health Commercial |
$1,516.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,516.50
|
| Rate for Payer: GEHA Commercial |
$1,179.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,516.50
|
| Rate for Payer: Multiplan All |
$1,533.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,179.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,516.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,600.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,263.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,567.05
|
| Rate for Payer: Zelis Auto |
$674.00
|
|
|
IMPLT SCREW CANCELLOUS 6.5X90MM
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.25 |
| Max. Negotiated Rate |
$1,600.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,011.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,432.25
|
| Rate for Payer: First Health Commercial |
$1,516.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,516.50
|
| Rate for Payer: GEHA Commercial |
$1,348.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,516.50
|
| Rate for Payer: Humana ChoiceCare |
$438.10
|
| Rate for Payer: Multiplan All |
$1,533.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,011.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,179.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,516.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,600.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,263.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,482.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$421.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,567.05
|
| Rate for Payer: Zelis Auto |
$674.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$842.50
|
|
|
IMPLT SCREW CANCELLOUS 6.5X95MM
|
Facility
|
IP
|
$1,296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.40 |
| Max. Negotiated Rate |
$1,231.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,036.80
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: First Health Commercial |
$1,166.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,166.40
|
| Rate for Payer: GEHA Commercial |
$907.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,166.40
|
| Rate for Payer: Multiplan All |
$1,179.36
|
| Rate for Payer: OMNI Networks Commercial |
$907.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,166.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,231.20
|
| Rate for Payer: Three Rivers Provider Network All |
$972.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,205.28
|
| Rate for Payer: Zelis Auto |
$518.40
|
|
|
IMPLT SCREW CANCELLOUS 6.5X95MM
|
Facility
|
OP
|
$1,296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,231.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$1,101.60
|
| Rate for Payer: First Health Commercial |
$1,166.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,166.40
|
| Rate for Payer: GEHA Commercial |
$1,036.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,166.40
|
| Rate for Payer: Humana ChoiceCare |
$336.96
|
| Rate for Payer: Multiplan All |
$1,179.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$777.60
|
| Rate for Payer: OMNI Networks Commercial |
$907.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,166.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,231.20
|
| Rate for Payer: Three Rivers Provider Network All |
$972.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,140.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$324.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,205.28
|
| Rate for Payer: Zelis Auto |
$518.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$648.00
|
|
|
IMPLT SCREW CANCELLOUS 70MM
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003035
|
|
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 70MM
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003035
|
|
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 ACETABULAR
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000510
|
|
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 ACETABULAR
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000510
|
|
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 BONE 6.5X25MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000511
|
|
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 BONE 6.5X25MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000511
|
|
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 F/T 4.0X32MM
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.50 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: First Health Commercial |
$131.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$131.40
|
| Rate for Payer: GEHA Commercial |
$116.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$131.40
|
| Rate for Payer: Humana ChoiceCare |
$37.96
|
| Rate for Payer: Multiplan All |
$132.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$87.60
|
| Rate for Payer: OMNI Networks Commercial |
$102.20
|
| Rate for Payer: One Health Plan PPO/POS |
$131.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$138.70
|
| Rate for Payer: Three Rivers Provider Network All |
$109.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$128.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$135.78
|
| Rate for Payer: Zelis Auto |
$58.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$73.00
|
|
|
IMPLT SCREW CANCELLOUS F/T 4.0X32MM
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.80
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: First Health Commercial |
$131.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$131.40
|
| Rate for Payer: GEHA Commercial |
$102.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$131.40
|
| Rate for Payer: Multiplan All |
$132.86
|
| Rate for Payer: OMNI Networks Commercial |
$102.20
|
| Rate for Payer: One Health Plan PPO/POS |
$131.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$138.70
|
| Rate for Payer: Three Rivers Provider Network All |
$109.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$135.78
|
| Rate for Payer: Zelis Auto |
$58.40
|
|
|
IMPLT SCREW CANCELLOUS PINNACLE 6.5X15MM
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$356.40 |
| Max. Negotiated Rate |
$846.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$712.80
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna Commercial |
$757.35
|
| Rate for Payer: First Health Commercial |
$801.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$801.90
|
| Rate for Payer: GEHA Commercial |
$623.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$801.90
|
| Rate for Payer: Multiplan All |
$810.81
|
| Rate for Payer: OMNI Networks Commercial |
$623.70
|
| Rate for Payer: One Health Plan PPO/POS |
$801.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$846.45
|
| Rate for Payer: Three Rivers Provider Network All |
$668.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$828.63
|
| Rate for Payer: Zelis Auto |
$356.40
|
|
|
IMPLT SCREW CANCELLOUS PINNACLE 6.5X15MM
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.75 |
| Max. Negotiated Rate |
$846.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna Commercial |
$757.35
|
| Rate for Payer: First Health Commercial |
$801.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$801.90
|
| Rate for Payer: GEHA Commercial |
$712.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$801.90
|
| Rate for Payer: Humana ChoiceCare |
$231.66
|
| Rate for Payer: Multiplan All |
$810.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$534.60
|
| Rate for Payer: OMNI Networks Commercial |
$623.70
|
| Rate for Payer: One Health Plan PPO/POS |
$801.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$846.45
|
| Rate for Payer: Three Rivers Provider Network All |
$668.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$784.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$222.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$828.63
|
| Rate for Payer: Zelis Auto |
$356.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$445.50
|
|
