|
IMPLT SCREW HA 6X25MM
|
Facility
|
OP
|
$1,119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.75 |
| Max. Negotiated Rate |
$1,063.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna Commercial |
$951.15
|
| Rate for Payer: First Health Commercial |
$1,007.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,007.10
|
| Rate for Payer: GEHA Commercial |
$895.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,007.10
|
| Rate for Payer: Humana ChoiceCare |
$290.94
|
| Rate for Payer: Multiplan All |
$1,018.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$671.40
|
| Rate for Payer: OMNI Networks Commercial |
$783.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,007.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,063.05
|
| Rate for Payer: Three Rivers Provider Network All |
$839.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$984.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,040.67
|
| Rate for Payer: Zelis Auto |
$447.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$559.50
|
|
|
IMPLT SCREW HA 7X25MM
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$760.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
|
|
IMPLT SCREW HA 7X25MM
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$868.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Humana ChoiceCare |
$282.36
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$651.60
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$955.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$543.00
|
|
|
IMPLT SCREW HA 7X30MM
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$760.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
|
|
IMPLT SCREW HA 7X30MM
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$868.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Humana ChoiceCare |
$282.36
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$651.60
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$955.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$543.00
|
|
|
IMPLT SCREW HA 8X20MM
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$132.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Humana ChoiceCare |
$42.90
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$99.00
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$82.50
|
|
|
IMPLT SCREW HA 8X20MM
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$115.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
|
|
IMPLT SCREW HA 8X25MM
|
Facility
|
IP
|
$1,119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$1,063.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$895.20
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna Commercial |
$951.15
|
| Rate for Payer: First Health Commercial |
$1,007.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,007.10
|
| Rate for Payer: GEHA Commercial |
$783.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,007.10
|
| Rate for Payer: Multiplan All |
$1,018.29
|
| Rate for Payer: OMNI Networks Commercial |
$783.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,007.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,063.05
|
| Rate for Payer: Three Rivers Provider Network All |
$839.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,040.67
|
| Rate for Payer: Zelis Auto |
$447.60
|
|
|
IMPLT SCREW HA 8X25MM
|
Facility
|
OP
|
$1,119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.75 |
| Max. Negotiated Rate |
$1,063.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna Commercial |
$951.15
|
| Rate for Payer: First Health Commercial |
$1,007.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,007.10
|
| Rate for Payer: GEHA Commercial |
$895.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,007.10
|
| Rate for Payer: Humana ChoiceCare |
$290.94
|
| Rate for Payer: Multiplan All |
$1,018.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$671.40
|
| Rate for Payer: OMNI Networks Commercial |
$783.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,007.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,063.05
|
| Rate for Payer: Three Rivers Provider Network All |
$839.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$984.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,040.67
|
| Rate for Payer: Zelis Auto |
$447.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$559.50
|
|
|
IMPLT SCREW HA 8X30MM
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$760.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
|
|
IMPLT SCREW HA 8X30MM
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$868.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Humana ChoiceCare |
$282.36
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$651.60
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$955.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$543.00
|
|
|
IMPLT SCREW HA 8X35MM
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$760.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
|
|
IMPLT SCREW HA 8X35MM
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$868.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Humana ChoiceCare |
$282.36
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$651.60
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$955.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$543.00
|
|
|
IMPLT SCREW HA 9X20MM
|
Facility
|
IP
|
$1,119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$1,063.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$895.20
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna Commercial |
$951.15
|
| Rate for Payer: First Health Commercial |
$1,007.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,007.10
|
| Rate for Payer: GEHA Commercial |
$783.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,007.10
|
| Rate for Payer: Multiplan All |
$1,018.29
|
| Rate for Payer: OMNI Networks Commercial |
$783.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,007.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,063.05
|
| Rate for Payer: Three Rivers Provider Network All |
$839.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,040.67
|
| Rate for Payer: Zelis Auto |
$447.60
|
|
|
IMPLT SCREW HA 9X20MM
|
Facility
|
OP
|
$1,119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.75 |
| Max. Negotiated Rate |
$1,063.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna Commercial |
$951.15
|
| Rate for Payer: First Health Commercial |
$1,007.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,007.10
|
| Rate for Payer: GEHA Commercial |
$895.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,007.10
|
| Rate for Payer: Humana ChoiceCare |
$290.94
|
| Rate for Payer: Multiplan All |
$1,018.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$671.40
|
| Rate for Payer: OMNI Networks Commercial |
$783.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,007.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,063.05
|
| Rate for Payer: Three Rivers Provider Network All |
$839.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$984.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,040.67
|
| Rate for Payer: Zelis Auto |
$447.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$559.50
|
|
|
IMPLT SCREW HA 9X25MM
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$868.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Humana ChoiceCare |
$282.36
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$651.60
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$955.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$543.00
|
|
|
IMPLT SCREW HA 9X25MM
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$760.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
|
|
IMPLT SCREW HA 9X30MM
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$760.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
|
|
IMPLT SCREW HA 9X30MM
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$868.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Humana ChoiceCare |
$282.36
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$651.60
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$955.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$543.00
|
|
|
IMPLT SCREW HA 9X35MM
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.80 |
| Max. Negotiated Rate |
$1,108.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$933.60
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cigna Commercial |
$991.95
|
| Rate for Payer: First Health Commercial |
$1,050.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,050.30
|
| Rate for Payer: GEHA Commercial |
$816.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,050.30
|
| Rate for Payer: Multiplan All |
$1,061.97
|
| Rate for Payer: OMNI Networks Commercial |
$816.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,050.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,108.65
|
| Rate for Payer: Three Rivers Provider Network All |
$875.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,085.31
|
| Rate for Payer: Zelis Auto |
$466.80
|
|
|
IMPLT SCREW HA 9X35MM
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.75 |
| Max. Negotiated Rate |
$1,108.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cigna Commercial |
$991.95
|
| Rate for Payer: First Health Commercial |
$1,050.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,050.30
|
| Rate for Payer: GEHA Commercial |
$933.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,050.30
|
| Rate for Payer: Humana ChoiceCare |
$303.42
|
| Rate for Payer: Multiplan All |
$1,061.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$700.20
|
| Rate for Payer: OMNI Networks Commercial |
$816.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,050.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,108.65
|
| Rate for Payer: Three Rivers Provider Network All |
$875.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,026.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$291.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,085.31
|
| Rate for Payer: Zelis Auto |
$466.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$583.50
|
|
|
IMPLT SCREW HAND/WRIST 1.2X5MM
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.75 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$330.60
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cigna Commercial |
$468.35
|
| Rate for Payer: First Health Commercial |
$495.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$495.90
|
| Rate for Payer: GEHA Commercial |
$440.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$495.90
|
| Rate for Payer: Humana ChoiceCare |
$143.26
|
| Rate for Payer: Multiplan All |
$501.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$330.60
|
| Rate for Payer: OMNI Networks Commercial |
$385.70
|
| Rate for Payer: One Health Plan PPO/POS |
$495.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$523.45
|
| Rate for Payer: Three Rivers Provider Network All |
$413.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$484.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$512.43
|
| Rate for Payer: Zelis Auto |
$220.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.50
|
|
|
IMPLT SCREW HAND/WRIST 1.2X5MM
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$440.80
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cigna Commercial |
$468.35
|
| Rate for Payer: First Health Commercial |
$495.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$495.90
|
| Rate for Payer: GEHA Commercial |
$385.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$495.90
|
| Rate for Payer: Multiplan All |
$501.41
|
| Rate for Payer: OMNI Networks Commercial |
$385.70
|
| Rate for Payer: One Health Plan PPO/POS |
$495.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$523.45
|
| Rate for Payer: Three Rivers Provider Network All |
$413.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$512.43
|
| Rate for Payer: Zelis Auto |
$220.40
|
|
|
IMPLT SCREW HAND/WRIST 1.4X5MM
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$440.80
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cigna Commercial |
$468.35
|
| Rate for Payer: First Health Commercial |
$495.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$495.90
|
| Rate for Payer: GEHA Commercial |
$385.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$495.90
|
| Rate for Payer: Multiplan All |
$501.41
|
| Rate for Payer: OMNI Networks Commercial |
$385.70
|
| Rate for Payer: One Health Plan PPO/POS |
$495.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$523.45
|
| Rate for Payer: Three Rivers Provider Network All |
$413.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$512.43
|
| Rate for Payer: Zelis Auto |
$220.40
|
|
|
IMPLT SCREW HAND/WRIST 1.4X5MM
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.75 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$330.60
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cigna Commercial |
$468.35
|
| Rate for Payer: First Health Commercial |
$495.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$495.90
|
| Rate for Payer: GEHA Commercial |
$440.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$495.90
|
| Rate for Payer: Humana ChoiceCare |
$143.26
|
| Rate for Payer: Multiplan All |
$501.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$330.60
|
| Rate for Payer: OMNI Networks Commercial |
$385.70
|
| Rate for Payer: One Health Plan PPO/POS |
$495.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$523.45
|
| Rate for Payer: Three Rivers Provider Network All |
$413.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$484.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$512.43
|
| Rate for Payer: Zelis Auto |
$220.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.50
|
|
