|
IMPLT SCREW CANNULATED 6.5X85MM
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006150
|
|
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 6.5X85MM
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006150
|
|
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 6.5X90MM
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006151
|
|
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 6.5X90MM
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006151
|
|
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 6.5X95MM
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$345.60
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$367.20
|
| Rate for Payer: First Health Commercial |
$388.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$388.80
|
| Rate for Payer: GEHA Commercial |
$302.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$388.80
|
| Rate for Payer: Multiplan All |
$393.12
|
| Rate for Payer: OMNI Networks Commercial |
$302.40
|
| Rate for Payer: One Health Plan PPO/POS |
$388.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$410.40
|
| Rate for Payer: Three Rivers Provider Network All |
$324.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$401.76
|
| Rate for Payer: Zelis Auto |
$172.80
|
|
|
IMPLT SCREW CANNULATED 6.5X95MM
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$367.20
|
| Rate for Payer: First Health Commercial |
$388.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$388.80
|
| Rate for Payer: GEHA Commercial |
$345.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$388.80
|
| Rate for Payer: Humana ChoiceCare |
$112.32
|
| Rate for Payer: Multiplan All |
$393.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.20
|
| Rate for Payer: OMNI Networks Commercial |
$302.40
|
| Rate for Payer: One Health Plan PPO/POS |
$388.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$410.40
|
| Rate for Payer: Three Rivers Provider Network All |
$324.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$380.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$108.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$401.76
|
| Rate for Payer: Zelis Auto |
$172.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$216.00
|
|
|
IMPLT SCREW CANNULATED ASNIS 5.0X20MM
|
Facility
|
IP
|
$873.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002538
|
|
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 ASNIS 5.0X20MM
|
Facility
|
OP
|
$873.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002538
|
|
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 ASNIS 5.0X28MM
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.25 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$238.42
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$550.20
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$806.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$229.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$458.50
|
|
|
IMPLT SCREW CANNULATED ASNIS 5.0X28MM
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.60
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
|
|
IMPLT SCREW CANNULATED ASNIS 5.0X30MM
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.25 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$238.42
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$550.20
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$806.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$229.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$458.50
|
|
|
IMPLT SCREW CANNULATED ASNIS 5.0X30MM
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.60
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
|
|
IMPLT SCREW CANNULATED ASNIS 5.0X32MM
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.60
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
|
|
IMPLT SCREW CANNULATED ASNIS 5.0X32MM
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.25 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$238.42
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$550.20
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$806.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$229.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$458.50
|
|
|
IMPLT SCREW CANNULATED ASNIS 5.0X40MM
|
Facility
|
IP
|
$873.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002539
|
|
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 ASNIS 5.0X40MM
|
Facility
|
OP
|
$873.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002539
|
|
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 ASNIS 5.0X70MM
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.25 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$238.42
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$550.20
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$806.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$229.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$458.50
|
|
|
IMPLT SCREW CANNULATED ASNIS 5.0X70MM
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.60
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
|
|
IMPLT SCREW CANNULATED SHORT 4.0X34MM
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.60 |
| Max. Negotiated Rate |
$1,267.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,067.20
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cigna Commercial |
$1,133.90
|
| Rate for Payer: First Health Commercial |
$1,200.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,200.60
|
| Rate for Payer: GEHA Commercial |
$933.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,200.60
|
| Rate for Payer: Multiplan All |
$1,213.94
|
| Rate for Payer: OMNI Networks Commercial |
$933.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,200.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,267.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,000.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,240.62
|
| Rate for Payer: Zelis Auto |
$533.60
|
|
|
IMPLT SCREW CANNULATED SHORT 4.0X34MM
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.50 |
| Max. Negotiated Rate |
$1,267.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$800.40
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cigna Commercial |
$1,133.90
|
| Rate for Payer: First Health Commercial |
$1,200.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,200.60
|
| Rate for Payer: GEHA Commercial |
$1,067.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,200.60
|
| Rate for Payer: Humana ChoiceCare |
$346.84
|
| Rate for Payer: Multiplan All |
$1,213.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$800.40
|
| Rate for Payer: OMNI Networks Commercial |
$933.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,200.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,267.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,000.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,173.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$333.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,240.62
|
| Rate for Payer: Zelis Auto |
$533.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$667.00
|
|
|
IMPLT SCREW CANNULATED TAP 3.5MM
|
Facility
|
OP
|
$2,191.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.75 |
| Max. Negotiated Rate |
$2,081.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,314.60
|
| Rate for Payer: Cash Price |
$1,314.60
|
| Rate for Payer: Cash Price |
$1,314.60
|
| Rate for Payer: Cigna Commercial |
$1,862.35
|
| Rate for Payer: First Health Commercial |
$1,971.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,971.90
|
| Rate for Payer: GEHA Commercial |
$1,752.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,971.90
|
| Rate for Payer: Humana ChoiceCare |
$569.66
|
| Rate for Payer: Multiplan All |
$1,993.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,314.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,533.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,971.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,081.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,643.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,928.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$547.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,037.63
|
| Rate for Payer: Zelis Auto |
$876.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,095.50
|
|
|
IMPLT SCREW CANNULATED TAP 3.5MM
|
Facility
|
IP
|
$2,191.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.40 |
| Max. Negotiated Rate |
$2,081.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,752.80
|
| Rate for Payer: Cash Price |
$1,314.60
|
| Rate for Payer: Cash Price |
$1,314.60
|
| Rate for Payer: Cigna Commercial |
$1,862.35
|
| Rate for Payer: First Health Commercial |
$1,971.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,971.90
|
| Rate for Payer: GEHA Commercial |
$1,533.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,971.90
|
| Rate for Payer: Multiplan All |
$1,993.81
|
| Rate for Payer: OMNI Networks Commercial |
$1,533.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,971.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,081.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,643.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,037.63
|
| Rate for Payer: Zelis Auto |
$876.40
|
|
|
IMPLT SCREW CANNULATED THREADED 3.5X30MM
|
Facility
|
OP
|
$1,313.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.25 |
| Max. Negotiated Rate |
$1,247.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cigna Commercial |
$1,116.05
|
| Rate for Payer: First Health Commercial |
$1,181.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,181.70
|
| Rate for Payer: GEHA Commercial |
$1,050.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,181.70
|
| Rate for Payer: Humana ChoiceCare |
$341.38
|
| Rate for Payer: Multiplan All |
$1,194.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$787.80
|
| Rate for Payer: OMNI Networks Commercial |
$919.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,181.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,247.35
|
| Rate for Payer: Three Rivers Provider Network All |
$984.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,155.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$328.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,221.09
|
| Rate for Payer: Zelis Auto |
$525.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$656.50
|
|
|
IMPLT SCREW CANNULATED THREADED 3.5X30MM
|
Facility
|
IP
|
$1,313.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.20 |
| Max. Negotiated Rate |
$1,247.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,050.40
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cigna Commercial |
$1,116.05
|
| Rate for Payer: First Health Commercial |
$1,181.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,181.70
|
| Rate for Payer: GEHA Commercial |
$919.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,181.70
|
| Rate for Payer: Multiplan All |
$1,194.83
|
| Rate for Payer: OMNI Networks Commercial |
$919.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,181.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,247.35
|
| Rate for Payer: Three Rivers Provider Network All |
$984.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,221.09
|
| Rate for Payer: Zelis Auto |
$525.20
|
|
|
IMPLT SCREW CANNULATED THREADED 4.0X24MM
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.20 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$958.40
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$838.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
|
