|
IMPLT SCREW CANNULATED 4.0X55MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003087
|
|
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 4.0X55MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003087
|
|
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 4.0X58MM
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002561
|
|
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
|
|
|
IMPLT SCREW CANNULATED 4.0X58MM
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002561
|
|
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 4.0X60MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006339
|
|
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 4.0X60MM
|
Facility
|
OP
|
$1,296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006131
|
|
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 4.0X60MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006339
|
|
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 4.0X60MM
|
Facility
|
IP
|
$1,296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006131
|
|
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 4.0X65MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006340
|
|
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 4.0X65MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006340
|
|
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 4.0X 70MM
|
Facility
|
IP
|
$1,296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006130
|
|
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 4.0X 70MM
|
Facility
|
OP
|
$1,296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006130
|
|
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 4.0X70MM
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001402
|
|
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
|
|
|
IMPLT SCREW CANNULATED 4.0X70MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006341
|
|
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 4.0X70MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006341
|
|
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 4.0X70MM
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001402
|
|
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 42X14MM
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000810
|
|
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 42X14MM
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000810
|
|
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 48X4.0MM
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.25 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$1,012.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$328.90
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$759.00
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,113.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$316.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: Zelis Auto |
$506.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$632.50
|
|
|
IMPLT SCREW CANNULATED 48X4.0MM
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.00 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,012.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$885.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: Zelis Auto |
$506.00
|
|
|
IMPLT SCREW CANNULATED 5.0X40MM
|
Facility
|
OP
|
$873.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$218.25 |
| Max. Negotiated Rate |
$829.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$742.05
|
| Rate for Payer: First Health Commercial |
$785.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$785.70
|
| Rate for Payer: GEHA Commercial |
$698.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$785.70
|
| Rate for Payer: Humana ChoiceCare |
$226.98
|
| Rate for Payer: Multiplan All |
$794.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$523.80
|
| Rate for Payer: OMNI Networks Commercial |
$611.10
|
| Rate for Payer: One Health Plan PPO/POS |
$785.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$829.35
|
| Rate for Payer: Three Rivers Provider Network All |
$654.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$768.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$218.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$811.89
|
| Rate for Payer: Zelis Auto |
$349.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$436.50
|
|
|
IMPLT SCREW CANNULATED 5.0X40MM
|
Facility
|
IP
|
$873.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.20 |
| Max. Negotiated Rate |
$829.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$698.40
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$742.05
|
| Rate for Payer: First Health Commercial |
$785.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$785.70
|
| Rate for Payer: GEHA Commercial |
$611.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$785.70
|
| Rate for Payer: Multiplan All |
$794.43
|
| Rate for Payer: OMNI Networks Commercial |
$611.10
|
| Rate for Payer: One Health Plan PPO/POS |
$785.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$829.35
|
| Rate for Payer: Three Rivers Provider Network All |
$654.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$811.89
|
| Rate for Payer: Zelis Auto |
$349.20
|
|
|
IMPLT SCREW CANNULATED 5.7MM
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.00 |
| Max. Negotiated Rate |
$1,113.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$703.20
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cigna Commercial |
$996.20
|
| Rate for Payer: First Health Commercial |
$1,054.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,054.80
|
| Rate for Payer: GEHA Commercial |
$937.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,054.80
|
| Rate for Payer: Humana ChoiceCare |
$304.72
|
| Rate for Payer: Multiplan All |
$1,066.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$703.20
|
| Rate for Payer: OMNI Networks Commercial |
$820.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,054.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,113.40
|
| Rate for Payer: Three Rivers Provider Network All |
$879.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,031.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$293.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.96
|
| Rate for Payer: Zelis Auto |
$468.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$586.00
|
|
|
IMPLT SCREW CANNULATED 5.7MM
|
Facility
|
IP
|
$1,172.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.80 |
| Max. Negotiated Rate |
$1,113.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$937.60
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cigna Commercial |
$996.20
|
| Rate for Payer: First Health Commercial |
$1,054.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,054.80
|
| Rate for Payer: GEHA Commercial |
$820.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,054.80
|
| Rate for Payer: Multiplan All |
$1,066.52
|
| Rate for Payer: OMNI Networks Commercial |
$820.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,054.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,113.40
|
| Rate for Payer: Three Rivers Provider Network All |
$879.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.96
|
| Rate for Payer: Zelis Auto |
$468.80
|
|
|
IMPLT SCREW CANNULATED 5.7MMX45
|
Facility
|
IP
|
$1,463.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$1,389.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,170.40
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$1,243.55
|
| Rate for Payer: First Health Commercial |
$1,316.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,316.70
|
| Rate for Payer: GEHA Commercial |
$1,024.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,316.70
|
| Rate for Payer: Multiplan All |
$1,331.33
|
| Rate for Payer: OMNI Networks Commercial |
$1,024.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,316.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,389.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,097.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,360.59
|
| Rate for Payer: Zelis Auto |
$585.20
|
|
