|
IMPLT SCREW CANNULATED 4.0X12MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
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
|
|
|
IMPLT SCREW CANNULATED 4.0X12MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW CANNULATED 4.0X14MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW CANNULATED 4.0X14MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW CANNULATED 4.0X16MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW CANNULATED 4.0X16MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW CANNULATED 4.0X18MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW CANNULATED 4.0X18MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW CANNULATED 4.0X20MM
|
Facility
|
IP
|
$1,296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006129
|
|
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 CANNULATED 4.0X20MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW CANNULATED 4.0X20MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW CANNULATED 4.0X20MM
|
Facility
|
OP
|
$1,296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006129
|
|
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 CANNULATED 4.0X26MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW CANNULATED 4.0X26MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW CANNULATED 4.0X28MM
|
Facility
|
IP
|
$792.64
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.06 |
| Max. Negotiated Rate |
$753.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$634.11
|
| Rate for Payer: Cash Price |
$475.58
|
| Rate for Payer: Cash Price |
$475.58
|
| Rate for Payer: Cigna Commercial |
$673.74
|
| Rate for Payer: First Health Commercial |
$713.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$713.38
|
| Rate for Payer: GEHA Commercial |
$554.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$713.38
|
| Rate for Payer: Multiplan All |
$721.30
|
| Rate for Payer: OMNI Networks Commercial |
$554.85
|
| Rate for Payer: One Health Plan PPO/POS |
$713.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$753.01
|
| Rate for Payer: Three Rivers Provider Network All |
$594.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$737.16
|
| Rate for Payer: Zelis Auto |
$317.06
|
|
|
IMPLT SCREW CANNULATED 4.0X28MM
|
Facility
|
OP
|
$792.64
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.16 |
| Max. Negotiated Rate |
$753.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$475.58
|
| Rate for Payer: Cash Price |
$475.58
|
| Rate for Payer: Cash Price |
$475.58
|
| Rate for Payer: Cigna Commercial |
$673.74
|
| Rate for Payer: First Health Commercial |
$713.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$713.38
|
| Rate for Payer: GEHA Commercial |
$634.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$713.38
|
| Rate for Payer: Humana ChoiceCare |
$206.09
|
| Rate for Payer: Multiplan All |
$721.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$475.58
|
| Rate for Payer: OMNI Networks Commercial |
$554.85
|
| Rate for Payer: One Health Plan PPO/POS |
$713.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$753.01
|
| Rate for Payer: Three Rivers Provider Network All |
$594.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$697.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$198.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$737.16
|
| Rate for Payer: Zelis Auto |
$317.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$396.32
|
|
|
IMPLT SCREW CANNULATED 4.0X30MM
|
Facility
|
IP
|
$792.64
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.06 |
| Max. Negotiated Rate |
$753.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$634.11
|
| Rate for Payer: Cash Price |
$475.58
|
| Rate for Payer: Cash Price |
$475.58
|
| Rate for Payer: Cigna Commercial |
$673.74
|
| Rate for Payer: First Health Commercial |
$713.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$713.38
|
| Rate for Payer: GEHA Commercial |
$554.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$713.38
|
| Rate for Payer: Multiplan All |
$721.30
|
| Rate for Payer: OMNI Networks Commercial |
$554.85
|
| Rate for Payer: One Health Plan PPO/POS |
$713.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$753.01
|
| Rate for Payer: Three Rivers Provider Network All |
$594.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$737.16
|
| Rate for Payer: Zelis Auto |
$317.06
|
|
|
IMPLT SCREW CANNULATED 4.0X30MM
|
Facility
|
OP
|
$792.64
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.16 |
| Max. Negotiated Rate |
$753.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$475.58
|
| Rate for Payer: Cash Price |
$475.58
|
| Rate for Payer: Cash Price |
$475.58
|
| Rate for Payer: Cigna Commercial |
$673.74
|
| Rate for Payer: First Health Commercial |
$713.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$713.38
|
| Rate for Payer: GEHA Commercial |
$634.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$713.38
|
| Rate for Payer: Humana ChoiceCare |
$206.09
|
| Rate for Payer: Multiplan All |
$721.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$475.58
|
| Rate for Payer: OMNI Networks Commercial |
$554.85
|
| Rate for Payer: One Health Plan PPO/POS |
$713.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$753.01
|
| Rate for Payer: Three Rivers Provider Network All |
$594.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$697.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$198.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$737.16
|
| Rate for Payer: Zelis Auto |
$317.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$396.32
|
|
|
IMPLT SCREW CANNULATED 4.0X32MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW CANNULATED 4.0X32MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW CANNULATED 4.0X34MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW CANNULATED 4.0X34MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW CANNULATED 4.0X36MM
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$844.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$738.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
|
|
IMPLT SCREW CANNULATED 4.0X36MM
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.75 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$844.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Humana ChoiceCare |
$274.30
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$633.00
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$928.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.50
|
|
