|
IMPLT SCREW CANNULATED 3.5X26MM
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000805
|
|
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 3.5X26MM
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000805
|
|
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 3.5X30MM
|
Facility
|
IP
|
$1,313.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.20 |
| Max. Negotiated Rate |
$1,247.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,050.40
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cigna Commercial |
$1,116.05
|
| Rate for Payer: First Health Commercial |
$1,181.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,181.70
|
| Rate for Payer: GEHA Commercial |
$919.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,181.70
|
| Rate for Payer: Multiplan All |
$1,194.83
|
| Rate for Payer: OMNI Networks Commercial |
$919.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,181.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,247.35
|
| Rate for Payer: Three Rivers Provider Network All |
$984.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,221.09
|
| Rate for Payer: Zelis Auto |
$525.20
|
|
|
IMPLT SCREW CANNULATED 3.5X30MM
|
Facility
|
OP
|
$1,313.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.25 |
| Max. Negotiated Rate |
$1,247.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cigna Commercial |
$1,116.05
|
| Rate for Payer: First Health Commercial |
$1,181.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,181.70
|
| Rate for Payer: GEHA Commercial |
$1,050.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,181.70
|
| Rate for Payer: Humana ChoiceCare |
$341.38
|
| Rate for Payer: Multiplan All |
$1,194.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$787.80
|
| Rate for Payer: OMNI Networks Commercial |
$919.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,181.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,247.35
|
| Rate for Payer: Three Rivers Provider Network All |
$984.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,155.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$328.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,221.09
|
| Rate for Payer: Zelis Auto |
$525.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$656.50
|
|
|
IMPLT SCREW CANNULATED 3.5X36MM
|
Facility
|
IP
|
$1,106.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.40 |
| Max. Negotiated Rate |
$1,050.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$884.80
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cigna Commercial |
$940.10
|
| Rate for Payer: First Health Commercial |
$995.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$995.40
|
| Rate for Payer: GEHA Commercial |
$774.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$995.40
|
| Rate for Payer: Multiplan All |
$1,006.46
|
| Rate for Payer: OMNI Networks Commercial |
$774.20
|
| Rate for Payer: One Health Plan PPO/POS |
$995.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,050.70
|
| Rate for Payer: Three Rivers Provider Network All |
$829.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,028.58
|
| Rate for Payer: Zelis Auto |
$442.40
|
|
|
IMPLT SCREW CANNULATED 3.5X36MM
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.50 |
| Max. Negotiated Rate |
$1,050.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$663.60
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cigna Commercial |
$940.10
|
| Rate for Payer: First Health Commercial |
$995.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$995.40
|
| Rate for Payer: GEHA Commercial |
$884.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$995.40
|
| Rate for Payer: Humana ChoiceCare |
$287.56
|
| Rate for Payer: Multiplan All |
$1,006.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$663.60
|
| Rate for Payer: OMNI Networks Commercial |
$774.20
|
| Rate for Payer: One Health Plan PPO/POS |
$995.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,050.70
|
| Rate for Payer: Three Rivers Provider Network All |
$829.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$973.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$276.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,028.58
|
| Rate for Payer: Zelis Auto |
$442.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$553.00
|
|
|
IMPLT SCREW CANNULATED 3.5X38MM
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000517
|
|
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 3.5X38MM
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000517
|
|
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 3.5X40MM
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001398
|
|
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 3.5X40MM
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001398
|
|
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 3.5X46MM
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001701
|
|
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 3.5X46MM
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001701
|
|
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 3.5X48MM
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.25 |
| Max. Negotiated Rate |
$1,114.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$703.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$997.05
|
| Rate for Payer: First Health Commercial |
$1,055.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,055.70
|
| Rate for Payer: GEHA Commercial |
$938.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,055.70
|
| Rate for Payer: Humana ChoiceCare |
$304.98
|
| Rate for Payer: Multiplan All |
$1,067.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$703.80
|
| Rate for Payer: OMNI Networks Commercial |
$821.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,055.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,114.35
|
| Rate for Payer: Three Rivers Provider Network All |
$879.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,032.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$293.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,090.89
|
| Rate for Payer: Zelis Auto |
$469.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$586.50
|
|
|
IMPLT SCREW CANNULATED 3.5X48MM
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.20 |
| Max. Negotiated Rate |
$1,114.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$938.40
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$997.05
|
| Rate for Payer: First Health Commercial |
$1,055.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,055.70
|
| Rate for Payer: GEHA Commercial |
$821.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,055.70
|
| Rate for Payer: Multiplan All |
$1,067.43
|
| Rate for Payer: OMNI Networks Commercial |
$821.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,055.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,114.35
|
| Rate for Payer: Three Rivers Provider Network All |
$879.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,090.89
|
| Rate for Payer: Zelis Auto |
$469.20
|
|
|
IMPLT SCREW CANNULATED 3.5X50MM
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001399
|
|
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 3.5X50MM
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001399
|
|
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 4.0 #345418
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$189.60
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$165.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
|
|
IMPLT SCREW CANNULATED 4.0 #345418
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$189.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Humana ChoiceCare |
$61.62
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.20
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$208.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$118.50
|
|
|
IMPLT SCREW CANNULATED 4.0MM
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,912.50
|
| Rate for Payer: First Health Commercial |
$2,025.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,025.00
|
| Rate for Payer: GEHA Commercial |
$1,800.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,025.00
|
| Rate for Payer: Humana ChoiceCare |
$585.00
|
| Rate for Payer: Multiplan All |
$2,047.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,350.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,575.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,025.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,137.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,687.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,980.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$562.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,092.50
|
| Rate for Payer: Zelis Auto |
$900.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,125.00
|
|
|
IMPLT SCREW CANNULATED 4.0MM
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$189.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Humana ChoiceCare |
$61.62
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.20
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$208.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$118.50
|
|
|
IMPLT SCREW CANNULATED 4.0MM
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$189.60
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$165.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
|
|
IMPLT SCREW CANNULATED 4.0MM
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.00 |
| Max. Negotiated Rate |
$2,142.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,804.00
|
| Rate for Payer: Cash Price |
$1,353.00
|
| Rate for Payer: Cash Price |
$1,353.00
|
| Rate for Payer: Cigna Commercial |
$1,916.75
|
| Rate for Payer: First Health Commercial |
$2,029.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,029.50
|
| Rate for Payer: GEHA Commercial |
$1,578.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,029.50
|
| Rate for Payer: Multiplan All |
$2,052.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,578.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,029.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,142.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,691.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,097.15
|
| Rate for Payer: Zelis Auto |
$902.00
|
|
|
IMPLT SCREW CANNULATED 4.0MM
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,912.50
|
| Rate for Payer: First Health Commercial |
$2,025.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,025.00
|
| Rate for Payer: GEHA Commercial |
$1,575.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,025.00
|
| Rate for Payer: Multiplan All |
$2,047.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,575.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,025.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,137.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,687.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,092.50
|
| Rate for Payer: Zelis Auto |
$900.00
|
|
|
IMPLT SCREW CANNULATED 4.0MM
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.75 |
| Max. Negotiated Rate |
$2,142.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,353.00
|
| Rate for Payer: Cash Price |
$1,353.00
|
| Rate for Payer: Cash Price |
$1,353.00
|
| Rate for Payer: Cigna Commercial |
$1,916.75
|
| Rate for Payer: First Health Commercial |
$2,029.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,029.50
|
| Rate for Payer: GEHA Commercial |
$1,804.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,029.50
|
| Rate for Payer: Humana ChoiceCare |
$586.30
|
| Rate for Payer: Multiplan All |
$2,052.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,353.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,578.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,029.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,142.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,691.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,984.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$563.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,097.15
|
| Rate for Payer: Zelis Auto |
$902.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,127.50
|
|
|
IMPLT SCREW CANNULATED 4.0X12MM
|
Facility
|
IP
|
$2,127.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$850.80 |
| Max. Negotiated Rate |
$2,020.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,701.60
|
| Rate for Payer: Cash Price |
$1,276.20
|
| Rate for Payer: Cash Price |
$1,276.20
|
| Rate for Payer: Cigna Commercial |
$1,807.95
|
| Rate for Payer: First Health Commercial |
$1,914.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,914.30
|
| Rate for Payer: GEHA Commercial |
$1,488.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,914.30
|
| Rate for Payer: Multiplan All |
$1,935.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,488.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,914.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,020.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,595.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,978.11
|
| Rate for Payer: Zelis Auto |
$850.80
|
|
