|
IMPLT SCREW CANNULATED 5.7MMX45
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.75 |
| Max. Negotiated Rate |
$1,389.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$877.80
|
| 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 |
$1,170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,316.70
|
| Rate for Payer: Humana ChoiceCare |
$380.38
|
| Rate for Payer: Multiplan All |
$1,331.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$877.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,287.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$365.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,360.59
|
| Rate for Payer: Zelis Auto |
$585.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$731.50
|
|
|
IMPLT SCREW CANNULATED 5.7MMX55
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.75 |
| Max. Negotiated Rate |
$1,389.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$877.80
|
| 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 |
$1,170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,316.70
|
| Rate for Payer: Humana ChoiceCare |
$380.38
|
| Rate for Payer: Multiplan All |
$1,331.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$877.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,287.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$365.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,360.59
|
| Rate for Payer: Zelis Auto |
$585.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$731.50
|
|
|
IMPLT SCREW CANNULATED 5.7MMX55
|
Facility
|
IP
|
$1,463.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000519
|
|
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
|
|
|
IMPLT SCREW CANNULATED 5.7MMX60
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.75 |
| Max. Negotiated Rate |
$1,389.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$877.80
|
| 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 |
$1,170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,316.70
|
| Rate for Payer: Humana ChoiceCare |
$380.38
|
| Rate for Payer: Multiplan All |
$1,331.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$877.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,287.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$365.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,360.59
|
| Rate for Payer: Zelis Auto |
$585.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$731.50
|
|
|
IMPLT SCREW CANNULATED 5.7MMX60
|
Facility
|
IP
|
$1,463.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000520
|
|
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
|
|
|
IMPLT SCREW CANNULATED 5.7MMX65
|
Facility
|
IP
|
$1,463.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000521
|
|
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
|
|
|
IMPLT SCREW CANNULATED 5.7MMX65
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.75 |
| Max. Negotiated Rate |
$1,389.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$877.80
|
| 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 |
$1,170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,316.70
|
| Rate for Payer: Humana ChoiceCare |
$380.38
|
| Rate for Payer: Multiplan All |
$1,331.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$877.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,287.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$365.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,360.59
|
| Rate for Payer: Zelis Auto |
$585.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$731.50
|
|
|
IMPLT SCREW CANNULATED 5X 44
|
Facility
|
IP
|
$4,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,656.00 |
| Max. Negotiated Rate |
$3,933.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,312.00
|
| Rate for Payer: Cash Price |
$2,484.00
|
| Rate for Payer: Cash Price |
$2,484.00
|
| Rate for Payer: Cigna Commercial |
$3,519.00
|
| Rate for Payer: First Health Commercial |
$3,726.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,726.00
|
| Rate for Payer: GEHA Commercial |
$2,898.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,726.00
|
| Rate for Payer: Multiplan All |
$3,767.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,898.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,726.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,933.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,105.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,850.20
|
| Rate for Payer: Zelis Auto |
$1,656.00
|
|
|
IMPLT SCREW CANNULATED 5X 44
|
Facility
|
OP
|
$4,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.00 |
| Max. Negotiated Rate |
$3,933.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,484.00
|
| Rate for Payer: Cash Price |
$2,484.00
|
| Rate for Payer: Cash Price |
$2,484.00
|
| Rate for Payer: Cigna Commercial |
$3,519.00
|
| Rate for Payer: First Health Commercial |
$3,726.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,726.00
|
| Rate for Payer: GEHA Commercial |
$3,312.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,726.00
|
| Rate for Payer: Humana ChoiceCare |
$1,076.40
|
| Rate for Payer: Multiplan All |
$3,767.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,484.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,898.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,726.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,933.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,105.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,643.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,035.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,850.20
|
| Rate for Payer: Zelis Auto |
$1,656.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,070.00
|
|
|
IMPLT SCREW CANNULATED 5X 50
|
Facility
|
IP
|
$4,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,656.00 |
| Max. Negotiated Rate |
$3,933.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,312.00
|
| Rate for Payer: Cash Price |
$2,484.00
|
| Rate for Payer: Cash Price |
$2,484.00
|
| Rate for Payer: Cigna Commercial |
$3,519.00
|
| Rate for Payer: First Health Commercial |
$3,726.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,726.00
|
| Rate for Payer: GEHA Commercial |
$2,898.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,726.00
|
| Rate for Payer: Multiplan All |
$3,767.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,898.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,726.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,933.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,105.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,850.20
|
| Rate for Payer: Zelis Auto |
$1,656.00
|
|
|
IMPLT SCREW CANNULATED 5X 50
|
Facility
|
OP
|
$4,140.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.00 |
| Max. Negotiated Rate |
$3,933.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,484.00
|
| Rate for Payer: Cash Price |
$2,484.00
|
| Rate for Payer: Cash Price |
$2,484.00
|
| Rate for Payer: Cigna Commercial |
$3,519.00
|
| Rate for Payer: First Health Commercial |
$3,726.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,726.00
|
| Rate for Payer: GEHA Commercial |
$3,312.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,726.00
|
| Rate for Payer: Humana ChoiceCare |
$1,076.40
|
| Rate for Payer: Multiplan All |
$3,767.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,484.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,898.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,726.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,933.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,105.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,643.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,035.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,850.20
|
| Rate for Payer: Zelis Auto |
$1,656.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,070.00
|
|
|
IMPLT SCREW CANNULATED 6.5PT
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.60 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$915.20
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$972.40
|
| Rate for Payer: First Health Commercial |
$1,029.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,029.60
|
| Rate for Payer: GEHA Commercial |
$800.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,029.60
|
| Rate for Payer: Multiplan All |
$1,041.04
|
| Rate for Payer: OMNI Networks Commercial |
$800.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,029.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,086.80
|
| Rate for Payer: Three Rivers Provider Network All |
$858.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,063.92
|
| Rate for Payer: Zelis Auto |
$457.60
|
|
|
IMPLT SCREW CANNULATED 6.5PT
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$972.40
|
| Rate for Payer: First Health Commercial |
$1,029.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,029.60
|
| Rate for Payer: GEHA Commercial |
$915.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,029.60
|
| Rate for Payer: Humana ChoiceCare |
$297.44
|
| Rate for Payer: Multiplan All |
$1,041.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$686.40
|
| Rate for Payer: OMNI Networks Commercial |
$800.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,029.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,086.80
|
| Rate for Payer: Three Rivers Provider Network All |
$858.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,006.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$286.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,063.92
|
| Rate for Payer: Zelis Auto |
$457.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$572.00
|
|
|
IMPLT SCREW CANNULATED 6.5X100MM
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$390.15
|
| Rate for Payer: First Health Commercial |
$413.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$413.10
|
| Rate for Payer: GEHA Commercial |
$367.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$413.10
|
| Rate for Payer: Humana ChoiceCare |
$119.34
|
| Rate for Payer: Multiplan All |
$417.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$275.40
|
| Rate for Payer: OMNI Networks Commercial |
$321.30
|
| Rate for Payer: One Health Plan PPO/POS |
$413.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$436.05
|
| Rate for Payer: Three Rivers Provider Network All |
$344.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$403.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$426.87
|
| Rate for Payer: Zelis Auto |
$183.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.50
|
|
|
IMPLT SCREW CANNULATED 6.5X100MM
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$367.20
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$390.15
|
| Rate for Payer: First Health Commercial |
$413.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$413.10
|
| Rate for Payer: GEHA Commercial |
$321.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$413.10
|
| Rate for Payer: Multiplan All |
$417.69
|
| Rate for Payer: OMNI Networks Commercial |
$321.30
|
| Rate for Payer: One Health Plan PPO/POS |
$413.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$436.05
|
| Rate for Payer: Three Rivers Provider Network All |
$344.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$426.87
|
| Rate for Payer: Zelis Auto |
$183.60
|
|
|
IMPLT SCREW CANNULATED 6.5X46MM
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$1,216.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,088.00
|
| Rate for Payer: First Health Commercial |
$1,152.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.00
|
| Rate for Payer: GEHA Commercial |
$1,024.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.00
|
| Rate for Payer: Humana ChoiceCare |
$332.80
|
| Rate for Payer: Multiplan All |
$1,164.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$768.00
|
| Rate for Payer: OMNI Networks Commercial |
$896.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.00
|
| Rate for Payer: Three Rivers Provider Network All |
$960.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,126.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,190.40
|
| Rate for Payer: Zelis Auto |
$512.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$640.00
|
|
|
IMPLT SCREW CANNULATED 6.5X46MM
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.00 |
| Max. Negotiated Rate |
$1,216.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,024.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,088.00
|
| Rate for Payer: First Health Commercial |
$1,152.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.00
|
| Rate for Payer: GEHA Commercial |
$896.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.00
|
| Rate for Payer: Multiplan All |
$1,164.80
|
| Rate for Payer: OMNI Networks Commercial |
$896.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.00
|
| Rate for Payer: Three Rivers Provider Network All |
$960.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,190.40
|
| Rate for Payer: Zelis Auto |
$512.00
|
|
|
IMPLT SCREW CANNULATED 6.5X50MM
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.00 |
| Max. Negotiated Rate |
$1,216.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,024.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,088.00
|
| Rate for Payer: First Health Commercial |
$1,152.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.00
|
| Rate for Payer: GEHA Commercial |
$896.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.00
|
| Rate for Payer: Multiplan All |
$1,164.80
|
| Rate for Payer: OMNI Networks Commercial |
$896.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.00
|
| Rate for Payer: Three Rivers Provider Network All |
$960.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,190.40
|
| Rate for Payer: Zelis Auto |
$512.00
|
|
|
IMPLT SCREW CANNULATED 6.5X50MM
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$1,216.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,088.00
|
| Rate for Payer: First Health Commercial |
$1,152.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.00
|
| Rate for Payer: GEHA Commercial |
$1,024.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.00
|
| Rate for Payer: Humana ChoiceCare |
$332.80
|
| Rate for Payer: Multiplan All |
$1,164.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$768.00
|
| Rate for Payer: OMNI Networks Commercial |
$896.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.00
|
| Rate for Payer: Three Rivers Provider Network All |
$960.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,126.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,190.40
|
| Rate for Payer: Zelis Auto |
$512.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$640.00
|
|
|
IMPLT SCREW CANNULATED 6.5X55MM
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.60 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$915.20
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$972.40
|
| Rate for Payer: First Health Commercial |
$1,029.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,029.60
|
| Rate for Payer: GEHA Commercial |
$800.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,029.60
|
| Rate for Payer: Multiplan All |
$1,041.04
|
| Rate for Payer: OMNI Networks Commercial |
$800.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,029.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,086.80
|
| Rate for Payer: Three Rivers Provider Network All |
$858.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,063.92
|
| Rate for Payer: Zelis Auto |
$457.60
|
|
|
IMPLT SCREW CANNULATED 6.5X55MM
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$972.40
|
| Rate for Payer: First Health Commercial |
$1,029.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,029.60
|
| Rate for Payer: GEHA Commercial |
$915.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,029.60
|
| Rate for Payer: Humana ChoiceCare |
$297.44
|
| Rate for Payer: Multiplan All |
$1,041.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$686.40
|
| Rate for Payer: OMNI Networks Commercial |
$800.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,029.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,086.80
|
| Rate for Payer: Three Rivers Provider Network All |
$858.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,006.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$286.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,063.92
|
| Rate for Payer: Zelis Auto |
$457.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$572.00
|
|
|
IMPLT SCREW CANNULATED 6.5X65MM
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$381.25 |
| Max. Negotiated Rate |
$1,448.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$1,296.25
|
| Rate for Payer: First Health Commercial |
$1,372.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,372.50
|
| Rate for Payer: GEHA Commercial |
$1,220.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,372.50
|
| Rate for Payer: Humana ChoiceCare |
$396.50
|
| Rate for Payer: Multiplan All |
$1,387.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$915.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,067.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,372.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,448.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,342.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$381.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,418.25
|
| Rate for Payer: Zelis Auto |
$610.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$762.50
|
|
|
IMPLT SCREW CANNULATED 6.5X65MM
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.00 |
| Max. Negotiated Rate |
$1,448.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,220.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$1,296.25
|
| Rate for Payer: First Health Commercial |
$1,372.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,372.50
|
| Rate for Payer: GEHA Commercial |
$1,067.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,372.50
|
| Rate for Payer: Multiplan All |
$1,387.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,067.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,372.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,448.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,418.25
|
| Rate for Payer: Zelis Auto |
$610.00
|
|
|
IMPLT SCREW CANNULATED 6.5X70MM
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$972.40
|
| Rate for Payer: First Health Commercial |
$1,029.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,029.60
|
| Rate for Payer: GEHA Commercial |
$915.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,029.60
|
| Rate for Payer: Humana ChoiceCare |
$297.44
|
| Rate for Payer: Multiplan All |
$1,041.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$686.40
|
| Rate for Payer: OMNI Networks Commercial |
$800.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,029.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,086.80
|
| Rate for Payer: Three Rivers Provider Network All |
$858.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,006.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$286.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,063.92
|
| Rate for Payer: Zelis Auto |
$457.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$572.00
|
|
|
IMPLT SCREW CANNULATED 6.5X70MM
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.60 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$915.20
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$972.40
|
| Rate for Payer: First Health Commercial |
$1,029.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,029.60
|
| Rate for Payer: GEHA Commercial |
$800.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,029.60
|
| Rate for Payer: Multiplan All |
$1,041.04
|
| Rate for Payer: OMNI Networks Commercial |
$800.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,029.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,086.80
|
| Rate for Payer: Three Rivers Provider Network All |
$858.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,063.92
|
| Rate for Payer: Zelis Auto |
$457.60
|
|
