|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.20 |
| Max. Negotiated Rate |
$1,499.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,262.40
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cigna Commercial |
$1,341.30
|
| Rate for Payer: First Health Commercial |
$1,420.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,420.20
|
| Rate for Payer: GEHA Commercial |
$1,104.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,420.20
|
| Rate for Payer: Multiplan All |
$1,435.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,104.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,420.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,499.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,183.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,467.54
|
| Rate for Payer: Zelis Auto |
$631.20
|
|
|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
|
|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$192.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Humana ChoiceCare |
$62.40
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.00
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$211.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.00
|
|
|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
|
|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.50 |
| Max. Negotiated Rate |
$1,499.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$946.80
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cigna Commercial |
$1,341.30
|
| Rate for Payer: First Health Commercial |
$1,420.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,420.20
|
| Rate for Payer: GEHA Commercial |
$1,262.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,420.20
|
| Rate for Payer: Humana ChoiceCare |
$410.28
|
| Rate for Payer: Multiplan All |
$1,435.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$946.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,104.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,420.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,499.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,183.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,388.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$394.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,467.54
|
| Rate for Payer: Zelis Auto |
$631.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.00
|
|
|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.20
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.00
|
|
|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$540.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$472.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
|
|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
|
|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
OP
|
$389.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$369.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cigna Commercial |
$330.82
|
| Rate for Payer: First Health Commercial |
$350.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$350.28
|
| Rate for Payer: GEHA Commercial |
$311.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$350.28
|
| Rate for Payer: Humana ChoiceCare |
$101.19
|
| Rate for Payer: Multiplan All |
$354.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$233.52
|
| Rate for Payer: OMNI Networks Commercial |
$272.44
|
| Rate for Payer: One Health Plan PPO/POS |
$350.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.74
|
| Rate for Payer: Three Rivers Provider Network All |
$291.90
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$342.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.96
|
| Rate for Payer: Zelis Auto |
$155.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$194.60
|
|
|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
OP
|
$1,314.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.50 |
| Max. Negotiated Rate |
$1,248.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna Commercial |
$1,116.90
|
| Rate for Payer: First Health Commercial |
$1,182.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,182.60
|
| Rate for Payer: GEHA Commercial |
$1,051.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,182.60
|
| Rate for Payer: Humana ChoiceCare |
$341.64
|
| Rate for Payer: Multiplan All |
$1,195.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$788.40
|
| Rate for Payer: OMNI Networks Commercial |
$919.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,182.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,248.30
|
| Rate for Payer: Three Rivers Provider Network All |
$985.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,156.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$328.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,222.02
|
| Rate for Payer: Zelis Auto |
$525.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$657.00
|
|
|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
IP
|
$1,314.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.60 |
| Max. Negotiated Rate |
$1,248.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,051.20
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna Commercial |
$1,116.90
|
| Rate for Payer: First Health Commercial |
$1,182.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,182.60
|
| Rate for Payer: GEHA Commercial |
$919.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,182.60
|
| Rate for Payer: Multiplan All |
$1,195.74
|
| Rate for Payer: OMNI Networks Commercial |
$919.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,182.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,248.30
|
| Rate for Payer: Three Rivers Provider Network All |
$985.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,222.02
|
| Rate for Payer: Zelis Auto |
$525.60
|
|
|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
IP
|
$389.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$369.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$311.36
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cigna Commercial |
$330.82
|
| Rate for Payer: First Health Commercial |
$350.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$350.28
|
| Rate for Payer: GEHA Commercial |
$272.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$350.28
|
| Rate for Payer: Multiplan All |
$354.17
|
| Rate for Payer: OMNI Networks Commercial |
$272.44
|
| Rate for Payer: One Health Plan PPO/POS |
$350.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.74
|
| Rate for Payer: Three Rivers Provider Network All |
$291.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.96
|
| Rate for Payer: Zelis Auto |
$155.68
|
|
|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$79.30
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.00
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$268.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.50
|
|
|
IMPLT SCREW CORTICAL 3.5X14MM
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Humana ChoiceCare |
$175.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$405.00
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$594.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$337.50
|
|
|
IMPLT SCREW CORTICAL 3.5X16MM
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.75 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$210.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Humana ChoiceCare |
$68.38
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$157.80
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$231.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$131.50
|
|
|
IMPLT SCREW CORTICAL 3.5X16MM
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$210.40
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$184.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
|
|
IMPLT SCREW CORTICAL 3.5X16MM
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$221.60
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cigna Commercial |
$235.45
|
| Rate for Payer: First Health Commercial |
$249.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$249.30
|
| Rate for Payer: GEHA Commercial |
$193.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$249.30
|
| Rate for Payer: Multiplan All |
$252.07
|
| Rate for Payer: OMNI Networks Commercial |
$193.90
|
| Rate for Payer: One Health Plan PPO/POS |
$249.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$263.15
|
| Rate for Payer: Three Rivers Provider Network All |
$207.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$257.61
|
| Rate for Payer: Zelis Auto |
$110.80
|
|
|
IMPLT SCREW CORTICAL 3.5X16MM
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.25 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cigna Commercial |
$235.45
|
| Rate for Payer: First Health Commercial |
$249.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$249.30
|
| Rate for Payer: GEHA Commercial |
$221.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$249.30
|
| Rate for Payer: Humana ChoiceCare |
$72.02
|
| Rate for Payer: Multiplan All |
$252.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$166.20
|
| Rate for Payer: OMNI Networks Commercial |
$193.90
|
| Rate for Payer: One Health Plan PPO/POS |
$249.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$263.15
|
| Rate for Payer: Three Rivers Provider Network All |
$207.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$243.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$257.61
|
| Rate for Payer: Zelis Auto |
$110.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$138.50
|
|
|
IMPLT SCREW CORTICAL 3.5X18MM
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.20
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$135.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: Zelis Auto |
$77.60
|
|
|
IMPLT SCREW CORTICAL 3.5X18MM
|
Facility
|
OP
|
$389.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$369.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cigna Commercial |
$330.82
|
| Rate for Payer: First Health Commercial |
$350.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$350.28
|
| Rate for Payer: GEHA Commercial |
$311.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$350.28
|
| Rate for Payer: Humana ChoiceCare |
$101.19
|
| Rate for Payer: Multiplan All |
$354.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$233.52
|
| Rate for Payer: OMNI Networks Commercial |
$272.44
|
| Rate for Payer: One Health Plan PPO/POS |
$350.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.74
|
| Rate for Payer: Three Rivers Provider Network All |
$291.90
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$342.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.96
|
| Rate for Payer: Zelis Auto |
$155.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$194.60
|
|
|
IMPLT SCREW CORTICAL 3.5X18MM
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$155.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Humana ChoiceCare |
$50.44
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$116.40
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$170.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: Zelis Auto |
$77.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$97.00
|
|
|
IMPLT SCREW CORTICAL 3.5X18MM
|
Facility
|
IP
|
$389.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$369.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$311.36
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cigna Commercial |
$330.82
|
| Rate for Payer: First Health Commercial |
$350.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$350.28
|
| Rate for Payer: GEHA Commercial |
$272.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$350.28
|
| Rate for Payer: Multiplan All |
$354.17
|
| Rate for Payer: OMNI Networks Commercial |
$272.44
|
| Rate for Payer: One Health Plan PPO/POS |
$350.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.74
|
| Rate for Payer: Three Rivers Provider Network All |
$291.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.96
|
| Rate for Payer: Zelis Auto |
$155.68
|
|
|
IMPLT SCREW CORTICAL 3.5X20MM
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.20
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$160.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
|
|
IMPLT SCREW CORTICAL 3.5X20MM
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$177.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Humana ChoiceCare |
$57.72
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$133.20
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$195.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$111.00
|
|
|
IMPLT SCREW CORTICAL 3.5X20MM
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
|
