|
IMPLT SCREW PLATE RESTORATION 6.5X20MM
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.75 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cigna Commercial |
$638.35
|
| Rate for Payer: First Health Commercial |
$675.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.90
|
| Rate for Payer: GEHA Commercial |
$600.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.90
|
| Rate for Payer: Humana ChoiceCare |
$195.26
|
| Rate for Payer: Multiplan All |
$683.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$450.60
|
| Rate for Payer: OMNI Networks Commercial |
$525.70
|
| Rate for Payer: One Health Plan PPO/POS |
$675.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$713.45
|
| Rate for Payer: Three Rivers Provider Network All |
$563.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$660.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$187.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$698.43
|
| Rate for Payer: Zelis Auto |
$300.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$375.50
|
|
|
IMPLT SCREW PLATE RESTORATION 6.5X20MM
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.40 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$600.80
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cigna Commercial |
$638.35
|
| Rate for Payer: First Health Commercial |
$675.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.90
|
| Rate for Payer: GEHA Commercial |
$525.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.90
|
| Rate for Payer: Multiplan All |
$683.41
|
| Rate for Payer: OMNI Networks Commercial |
$525.70
|
| Rate for Payer: One Health Plan PPO/POS |
$675.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$713.45
|
| Rate for Payer: Three Rivers Provider Network All |
$563.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$698.43
|
| Rate for Payer: Zelis Auto |
$300.40
|
|
|
IMPLT SCREW PLATE RESTORATION 6.5X25MM
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.40 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$600.80
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cigna Commercial |
$638.35
|
| Rate for Payer: First Health Commercial |
$675.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.90
|
| Rate for Payer: GEHA Commercial |
$525.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.90
|
| Rate for Payer: Multiplan All |
$683.41
|
| Rate for Payer: OMNI Networks Commercial |
$525.70
|
| Rate for Payer: One Health Plan PPO/POS |
$675.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$713.45
|
| Rate for Payer: Three Rivers Provider Network All |
$563.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$698.43
|
| Rate for Payer: Zelis Auto |
$300.40
|
|
|
IMPLT SCREW PLATE RESTORATION 6.5X25MM
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.75 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cigna Commercial |
$638.35
|
| Rate for Payer: First Health Commercial |
$675.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.90
|
| Rate for Payer: GEHA Commercial |
$600.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.90
|
| Rate for Payer: Humana ChoiceCare |
$195.26
|
| Rate for Payer: Multiplan All |
$683.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$450.60
|
| Rate for Payer: OMNI Networks Commercial |
$525.70
|
| Rate for Payer: One Health Plan PPO/POS |
$675.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$713.45
|
| Rate for Payer: Three Rivers Provider Network All |
$563.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$660.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$187.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$698.43
|
| Rate for Payer: Zelis Auto |
$300.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$375.50
|
|
|
IMPLT SCREW PLATE RESTORATION 6.5X30MM
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$660.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$590.75
|
| Rate for Payer: First Health Commercial |
$625.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$625.50
|
| Rate for Payer: GEHA Commercial |
$486.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$625.50
|
| Rate for Payer: Multiplan All |
$632.45
|
| Rate for Payer: OMNI Networks Commercial |
$486.50
|
| Rate for Payer: One Health Plan PPO/POS |
$625.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$660.25
|
| Rate for Payer: Three Rivers Provider Network All |
$521.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$646.35
|
| Rate for Payer: Zelis Auto |
$278.00
|
|
|
IMPLT SCREW PLATE RESTORATION 6.5X30MM
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$173.75 |
| Max. Negotiated Rate |
$660.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$590.75
|
| Rate for Payer: First Health Commercial |
$625.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$625.50
|
| Rate for Payer: GEHA Commercial |
$556.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$625.50
|
| Rate for Payer: Humana ChoiceCare |
$180.70
|
| Rate for Payer: Multiplan All |
$632.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$417.00
|
| Rate for Payer: OMNI Networks Commercial |
$486.50
|
| Rate for Payer: One Health Plan PPO/POS |
$625.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$660.25
|
| Rate for Payer: Three Rivers Provider Network All |
$521.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$611.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$173.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$646.35
|
| Rate for Payer: Zelis Auto |
$278.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$347.50
|
|
|
IMPLT SCREW PLATE RESTORATION 6.5X35MM
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.40 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$600.80
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cigna Commercial |
$638.35
|
| Rate for Payer: First Health Commercial |
$675.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.90
|
| Rate for Payer: GEHA Commercial |
$525.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.90
|
| Rate for Payer: Multiplan All |
$683.41
|
| Rate for Payer: OMNI Networks Commercial |
$525.70
|
| Rate for Payer: One Health Plan PPO/POS |
$675.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$713.45
|
| Rate for Payer: Three Rivers Provider Network All |
$563.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$698.43
|
| Rate for Payer: Zelis Auto |
$300.40
|
|
|
IMPLT SCREW PLATE RESTORATION 6.5X35MM
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.75 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cigna Commercial |
$638.35
|
| Rate for Payer: First Health Commercial |
$675.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.90
|
| Rate for Payer: GEHA Commercial |
$600.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.90
|
| Rate for Payer: Humana ChoiceCare |
$195.26
|
| Rate for Payer: Multiplan All |
$683.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$450.60
|
| Rate for Payer: OMNI Networks Commercial |
$525.70
|
| Rate for Payer: One Health Plan PPO/POS |
$675.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$713.45
|
| Rate for Payer: Three Rivers Provider Network All |
$563.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$660.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$187.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$698.43
|
| Rate for Payer: Zelis Auto |
$300.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$375.50
|
|
|
IMPLT SCREW PLATE RESTORATION 6.5X40MM
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$669.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$599.25
|
| Rate for Payer: First Health Commercial |
$634.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$634.50
|
| Rate for Payer: GEHA Commercial |
$564.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$634.50
|
| Rate for Payer: Humana ChoiceCare |
$183.30
|
| Rate for Payer: Multiplan All |
$641.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$423.00
|
| Rate for Payer: OMNI Networks Commercial |
$493.50
|
| Rate for Payer: One Health Plan PPO/POS |
$634.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$669.75
|
| Rate for Payer: Three Rivers Provider Network All |
$528.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$620.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$176.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$655.65
|
| Rate for Payer: Zelis Auto |
$282.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$352.50
|
|
|
IMPLT SCREW PLATE RESTORATION 6.5X40MM
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.00 |
| Max. Negotiated Rate |
$669.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$564.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$599.25
|
| Rate for Payer: First Health Commercial |
$634.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$634.50
|
| Rate for Payer: GEHA Commercial |
$493.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$634.50
|
| Rate for Payer: Multiplan All |
$641.55
|
| Rate for Payer: OMNI Networks Commercial |
$493.50
|
| Rate for Payer: One Health Plan PPO/POS |
$634.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$669.75
|
| Rate for Payer: Three Rivers Provider Network All |
$528.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$655.65
|
| Rate for Payer: Zelis Auto |
$282.00
|
|
|
IMPLT SCREW PRO LO 3.5X12MM
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$300.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Humana ChoiceCare |
$97.76
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$225.60
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$330.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$188.00
|
|
|
IMPLT SCREW PRO LO 3.5X12MM
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.40 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.80
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
|
|
IMPLT SCREW RATT 5X15
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$1,263.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$798.00
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$1,130.50
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,197.00
|
| Rate for Payer: GEHA Commercial |
$1,064.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,197.00
|
| Rate for Payer: Humana ChoiceCare |
$345.80
|
| Rate for Payer: Multiplan All |
$1,210.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$798.00
|
| Rate for Payer: OMNI Networks Commercial |
$931.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,197.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,263.50
|
| Rate for Payer: Three Rivers Provider Network All |
$997.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,170.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$332.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,236.90
|
| Rate for Payer: Zelis Auto |
$532.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$665.00
|
|
|
IMPLT SCREW RATT 5X15
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$1,263.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,064.00
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$1,130.50
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,197.00
|
| Rate for Payer: GEHA Commercial |
$931.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,197.00
|
| Rate for Payer: Multiplan All |
$1,210.30
|
| Rate for Payer: OMNI Networks Commercial |
$931.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,197.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,263.50
|
| Rate for Payer: Three Rivers Provider Network All |
$997.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,236.90
|
| Rate for Payer: Zelis Auto |
$532.00
|
|
|
IMPLT SCREW REG 10X25MM
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Humana ChoiceCare |
$340.34
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$785.40
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,151.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$327.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$654.50
|
|
|
IMPLT SCREW REG 10X25MM
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,047.20
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
|
|
IMPLT SCREW REG 10X30MM
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Humana ChoiceCare |
$340.34
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$785.40
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,151.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$327.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$654.50
|
|
|
IMPLT SCREW REG 10X30MM
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,047.20
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
|
|
IMPLT SCREW REG 6X20MM
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.25 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$1,012.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$328.90
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$759.00
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,113.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$316.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: Zelis Auto |
$506.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$632.50
|
|
|
IMPLT SCREW REG 6X20MM
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.00 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,012.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$885.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: Zelis Auto |
$506.00
|
|
|
IMPLT SCREW REG 7X20MM
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.00 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,012.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$885.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: Zelis Auto |
$506.00
|
|
|
IMPLT SCREW REG 7X20MM
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.25 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$1,012.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$328.90
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$759.00
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,113.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$316.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: Zelis Auto |
$506.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$632.50
|
|
|
IMPLT SCREW REG 7X25MM
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.25 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$1,012.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$328.90
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$759.00
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,113.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$316.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: Zelis Auto |
$506.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$632.50
|
|
|
IMPLT SCREW REG 7X25MM
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.00 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,012.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$885.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: Zelis Auto |
$506.00
|
|
|
IMPLT SCREW REG 8X20MM
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Humana ChoiceCare |
$340.34
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$785.40
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,151.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$327.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$654.50
|
|
