|
IMPLT SCREW CANCELLOUS TORX 6.5X30MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000776
|
|
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 ZPFX 4X45MM
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.80
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$116.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
|
|
IMPLT SCREW CANCELLOUS ZPFX 4X45MM
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$132.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Humana ChoiceCare |
$43.16
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$99.60
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$83.00
|
|
|
IMPLT SCREW CANCELOUS F/T 4.0X14MM
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001282
|
|
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 CANCELOUS F/T 4.0X14MM
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001282
|
|
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 CAN F/T SYNTHES
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.20
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$132.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: Zelis Auto |
$75.60
|
|
|
IMPLT SCREW CAN F/T SYNTHES
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$151.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| Rate for Payer: Humana ChoiceCare |
$49.14
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$113.40
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$166.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: Zelis Auto |
$75.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$94.50
|
|
|
IMPLT SCREW CANNULATED 30MMX4.0
|
Facility
|
IP
|
$1,554.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.60 |
| Max. Negotiated Rate |
$1,476.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,243.20
|
| Rate for Payer: Cash Price |
$932.40
|
| Rate for Payer: Cash Price |
$932.40
|
| Rate for Payer: Cigna Commercial |
$1,320.90
|
| Rate for Payer: First Health Commercial |
$1,398.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,398.60
|
| Rate for Payer: GEHA Commercial |
$1,087.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,398.60
|
| Rate for Payer: Multiplan All |
$1,414.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,087.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,398.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,476.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,165.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,445.22
|
| Rate for Payer: Zelis Auto |
$621.60
|
|
|
IMPLT SCREW CANNULATED 30MMX4.0
|
Facility
|
OP
|
$1,554.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$388.50 |
| Max. Negotiated Rate |
$1,476.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$932.40
|
| Rate for Payer: Cash Price |
$932.40
|
| Rate for Payer: Cash Price |
$932.40
|
| Rate for Payer: Cigna Commercial |
$1,320.90
|
| Rate for Payer: First Health Commercial |
$1,398.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,398.60
|
| Rate for Payer: GEHA Commercial |
$1,243.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,398.60
|
| Rate for Payer: Humana ChoiceCare |
$404.04
|
| Rate for Payer: Multiplan All |
$1,414.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$932.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,087.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,398.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,476.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,165.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,367.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$388.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,445.22
|
| Rate for Payer: Zelis Auto |
$621.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$777.00
|
|
|
IMPLT SCREW CANNULATED 3.5MM 50X16MM
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.60 |
| Max. Negotiated Rate |
$1,105.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$931.20
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$814.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: Zelis Auto |
$465.60
|
|
|
IMPLT SCREW CANNULATED 3.5MM 50X16MM
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$1,105.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$931.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Humana ChoiceCare |
$302.64
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$698.40
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,024.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$291.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: Zelis Auto |
$465.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$582.00
|
|
|
IMPLT SCREW CANNULATED 3.5X12MM
|
Facility
|
OP
|
$1,581.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$395.25 |
| Max. Negotiated Rate |
$1,501.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$948.60
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cigna Commercial |
$1,343.85
|
| Rate for Payer: First Health Commercial |
$1,422.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,422.90
|
| Rate for Payer: GEHA Commercial |
$1,264.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,422.90
|
| Rate for Payer: Humana ChoiceCare |
$411.06
|
| Rate for Payer: Multiplan All |
$1,438.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$948.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,106.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,422.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,501.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,185.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,391.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$395.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,470.33
|
| Rate for Payer: Zelis Auto |
$632.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$790.50
|
|
|
IMPLT SCREW CANNULATED 3.5X12MM
|
Facility
|
IP
|
$1,581.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.40 |
| Max. Negotiated Rate |
$1,501.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,264.80
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cigna Commercial |
$1,343.85
|
| Rate for Payer: First Health Commercial |
$1,422.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,422.90
|
| Rate for Payer: GEHA Commercial |
$1,106.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,422.90
|
| Rate for Payer: Multiplan All |
$1,438.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,106.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,422.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,501.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,185.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,470.33
|
| Rate for Payer: Zelis Auto |
$632.40
|
|
|
IMPLT SCREW CANNULATED 3.5X14MM
|
Facility
|
IP
|
$1,354.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.60 |
| Max. Negotiated Rate |
$1,286.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,083.20
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cigna Commercial |
$1,150.90
|
| Rate for Payer: First Health Commercial |
$1,218.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,218.60
|
| Rate for Payer: GEHA Commercial |
$947.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,218.60
|
| Rate for Payer: Multiplan All |
$1,232.14
|
| Rate for Payer: OMNI Networks Commercial |
$947.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,218.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,286.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,015.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,259.22
|
| Rate for Payer: Zelis Auto |
$541.60
|
|
|
IMPLT SCREW CANNULATED 3.5X14MM
|
Facility
|
OP
|
$1,354.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.50 |
| Max. Negotiated Rate |
$1,286.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cigna Commercial |
$1,150.90
|
| Rate for Payer: First Health Commercial |
$1,218.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,218.60
|
| Rate for Payer: GEHA Commercial |
$1,083.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,218.60
|
| Rate for Payer: Humana ChoiceCare |
$352.04
|
| Rate for Payer: Multiplan All |
$1,232.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$812.40
|
| Rate for Payer: OMNI Networks Commercial |
$947.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,218.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,286.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,015.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,191.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$338.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,259.22
|
| Rate for Payer: Zelis Auto |
$541.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$677.00
|
|
|
IMPLT SCREW CANNULATED 3.5X16MM
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.25 |
| Max. Negotiated Rate |
$1,129.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$713.40
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$1,010.65
|
| Rate for Payer: First Health Commercial |
$1,070.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,070.10
|
| Rate for Payer: GEHA Commercial |
$951.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,070.10
|
| Rate for Payer: Humana ChoiceCare |
$309.14
|
| Rate for Payer: Multiplan All |
$1,081.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$713.40
|
| Rate for Payer: OMNI Networks Commercial |
$832.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,070.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,129.55
|
| Rate for Payer: Three Rivers Provider Network All |
$891.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,046.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$297.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,105.77
|
| Rate for Payer: Zelis Auto |
$475.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$594.50
|
|
|
IMPLT SCREW CANNULATED 3.5X16MM
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$256.80
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$272.85
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.90
|
| Rate for Payer: GEHA Commercial |
$224.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.90
|
| Rate for Payer: Multiplan All |
$292.11
|
| Rate for Payer: OMNI Networks Commercial |
$224.70
|
| Rate for Payer: One Health Plan PPO/POS |
$288.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.95
|
| Rate for Payer: Three Rivers Provider Network All |
$240.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$298.53
|
| Rate for Payer: Zelis Auto |
$128.40
|
|
|
IMPLT SCREW CANNULATED 3.5X16MM
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.25 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$272.85
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.90
|
| Rate for Payer: GEHA Commercial |
$256.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.90
|
| Rate for Payer: Humana ChoiceCare |
$83.46
|
| Rate for Payer: Multiplan All |
$292.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$192.60
|
| Rate for Payer: OMNI Networks Commercial |
$224.70
|
| Rate for Payer: One Health Plan PPO/POS |
$288.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.95
|
| Rate for Payer: Three Rivers Provider Network All |
$240.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$282.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$80.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$298.53
|
| Rate for Payer: Zelis Auto |
$128.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$160.50
|
|
|
IMPLT SCREW CANNULATED 3.5X16MM
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.60 |
| Max. Negotiated Rate |
$1,129.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$951.20
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$1,010.65
|
| Rate for Payer: First Health Commercial |
$1,070.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,070.10
|
| Rate for Payer: GEHA Commercial |
$832.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,070.10
|
| Rate for Payer: Multiplan All |
$1,081.99
|
| Rate for Payer: OMNI Networks Commercial |
$832.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,070.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,129.55
|
| Rate for Payer: Three Rivers Provider Network All |
$891.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,105.77
|
| Rate for Payer: Zelis Auto |
$475.60
|
|
|
IMPLT SCREW CANNULATED 3.5X20MM
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.75 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$141.95
|
| Rate for Payer: First Health Commercial |
$150.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$150.30
|
| Rate for Payer: GEHA Commercial |
$133.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$150.30
|
| Rate for Payer: Humana ChoiceCare |
$43.42
|
| Rate for Payer: Multiplan All |
$151.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$100.20
|
| Rate for Payer: OMNI Networks Commercial |
$116.90
|
| Rate for Payer: One Health Plan PPO/POS |
$150.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$158.65
|
| Rate for Payer: Three Rivers Provider Network All |
$125.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$155.31
|
| Rate for Payer: Zelis Auto |
$66.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$83.50
|
|
|
IMPLT SCREW CANNULATED 3.5X20MM
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.60 |
| Max. Negotiated Rate |
$1,105.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$931.20
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$814.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: Zelis Auto |
$465.60
|
|
|
IMPLT SCREW CANNULATED 3.5X20MM
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.80 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.60
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$141.95
|
| Rate for Payer: First Health Commercial |
$150.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$150.30
|
| Rate for Payer: GEHA Commercial |
$116.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$150.30
|
| Rate for Payer: Multiplan All |
$151.97
|
| Rate for Payer: OMNI Networks Commercial |
$116.90
|
| Rate for Payer: One Health Plan PPO/POS |
$150.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$158.65
|
| Rate for Payer: Three Rivers Provider Network All |
$125.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$155.31
|
| Rate for Payer: Zelis Auto |
$66.80
|
|
|
IMPLT SCREW CANNULATED 3.5X20MM
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$1,105.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$931.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Humana ChoiceCare |
$302.64
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$698.40
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,024.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$291.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: Zelis Auto |
$465.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$582.00
|
|
|
IMPLT SCREW CANNULATED 3.5X24MM
|
Facility
|
IP
|
$1,281.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.40 |
| Max. Negotiated Rate |
$1,216.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,024.80
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna Commercial |
$1,088.85
|
| Rate for Payer: First Health Commercial |
$1,152.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.90
|
| Rate for Payer: GEHA Commercial |
$896.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.90
|
| Rate for Payer: Multiplan All |
$1,165.71
|
| Rate for Payer: OMNI Networks Commercial |
$896.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.95
|
| Rate for Payer: Three Rivers Provider Network All |
$960.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,191.33
|
| Rate for Payer: Zelis Auto |
$512.40
|
|
|
IMPLT SCREW CANNULATED 3.5X24MM
|
Facility
|
OP
|
$1,281.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.25 |
| Max. Negotiated Rate |
$1,216.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna Commercial |
$1,088.85
|
| Rate for Payer: First Health Commercial |
$1,152.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.90
|
| Rate for Payer: GEHA Commercial |
$1,024.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.90
|
| Rate for Payer: Humana ChoiceCare |
$333.06
|
| Rate for Payer: Multiplan All |
$1,165.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$768.60
|
| Rate for Payer: OMNI Networks Commercial |
$896.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.95
|
| Rate for Payer: Three Rivers Provider Network All |
$960.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,127.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,191.33
|
| Rate for Payer: Zelis Auto |
$512.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$640.50
|
|
