|
K-WIRE DBL TROC .035X4"
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$7.80
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.00
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.00
|
|
|
K-WIRE DBL TROC .035X6"
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.80
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$26.35
|
| Rate for Payer: First Health Commercial |
$27.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.90
|
| Rate for Payer: GEHA Commercial |
$21.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.90
|
| Rate for Payer: Multiplan All |
$28.21
|
| Rate for Payer: OMNI Networks Commercial |
$21.70
|
| Rate for Payer: One Health Plan PPO/POS |
$27.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$29.45
|
| Rate for Payer: Three Rivers Provider Network All |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$28.83
|
| Rate for Payer: Zelis Auto |
$12.40
|
|
|
K-WIRE DBL TROC .035X6"
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$26.35
|
| Rate for Payer: First Health Commercial |
$27.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.90
|
| Rate for Payer: GEHA Commercial |
$24.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.90
|
| Rate for Payer: Humana ChoiceCare |
$8.06
|
| Rate for Payer: Multiplan All |
$28.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.60
|
| Rate for Payer: OMNI Networks Commercial |
$21.70
|
| Rate for Payer: One Health Plan PPO/POS |
$27.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$29.45
|
| Rate for Payer: Three Rivers Provider Network All |
$23.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$28.83
|
| Rate for Payer: Zelis Auto |
$12.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.50
|
|
|
K-WIRE DBL TROC .035X9"
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: First Health Commercial |
$29.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$29.70
|
| Rate for Payer: GEHA Commercial |
$26.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$29.70
|
| Rate for Payer: Humana ChoiceCare |
$8.58
|
| Rate for Payer: Multiplan All |
$30.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.80
|
| Rate for Payer: OMNI Networks Commercial |
$23.10
|
| Rate for Payer: One Health Plan PPO/POS |
$29.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.35
|
| Rate for Payer: Three Rivers Provider Network All |
$24.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$30.69
|
| Rate for Payer: Zelis Auto |
$13.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.50
|
|
|
K-WIRE DBL TROC .035X9"
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$26.40
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: First Health Commercial |
$29.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$29.70
|
| Rate for Payer: GEHA Commercial |
$23.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$29.70
|
| Rate for Payer: Multiplan All |
$30.03
|
| Rate for Payer: OMNI Networks Commercial |
$23.10
|
| Rate for Payer: One Health Plan PPO/POS |
$29.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.35
|
| Rate for Payer: Three Rivers Provider Network All |
$24.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$30.69
|
| Rate for Payer: Zelis Auto |
$13.20
|
|
|
K-WIRE DBL TROC .045X4"
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$7.80
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.00
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.00
|
|
|
K-WIRE DBL TROC .045X4"
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
|
|
K-WIRE DBL TROC .045X6"
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.80
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$26.35
|
| Rate for Payer: First Health Commercial |
$27.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.90
|
| Rate for Payer: GEHA Commercial |
$21.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.90
|
| Rate for Payer: Multiplan All |
$28.21
|
| Rate for Payer: OMNI Networks Commercial |
$21.70
|
| Rate for Payer: One Health Plan PPO/POS |
$27.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$29.45
|
| Rate for Payer: Three Rivers Provider Network All |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$28.83
|
| Rate for Payer: Zelis Auto |
$12.40
|
|
|
K-WIRE DBL TROC .045X6"
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$26.35
|
| Rate for Payer: First Health Commercial |
$27.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.90
|
| Rate for Payer: GEHA Commercial |
$24.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.90
|
| Rate for Payer: Humana ChoiceCare |
$8.06
|
| Rate for Payer: Multiplan All |
$28.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.60
|
| Rate for Payer: OMNI Networks Commercial |
$21.70
|
| Rate for Payer: One Health Plan PPO/POS |
$27.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$29.45
|
| Rate for Payer: Three Rivers Provider Network All |
$23.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$28.83
|
| Rate for Payer: Zelis Auto |
$12.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.50
|
|
|
K-WIRE DBL TROC .045X9"
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: First Health Commercial |
$29.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$29.70
|
| Rate for Payer: GEHA Commercial |
$26.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$29.70
|
| Rate for Payer: Humana ChoiceCare |
$8.58
|
| Rate for Payer: Multiplan All |
$30.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.80
|
| Rate for Payer: OMNI Networks Commercial |
$23.10
|
| Rate for Payer: One Health Plan PPO/POS |
$29.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.35
|
| Rate for Payer: Three Rivers Provider Network All |
$24.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$30.69
|
| Rate for Payer: Zelis Auto |
$13.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.50
|
|
|
K-WIRE DBL TROC .045X9"
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$26.40
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: First Health Commercial |
$29.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$29.70
|
| Rate for Payer: GEHA Commercial |
$23.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$29.70
|
| Rate for Payer: Multiplan All |
$30.03
|
| Rate for Payer: OMNI Networks Commercial |
$23.10
|
| Rate for Payer: One Health Plan PPO/POS |
$29.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.35
|
| Rate for Payer: Three Rivers Provider Network All |
$24.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$30.69
|
| Rate for Payer: Zelis Auto |
$13.20
|
|
|
K-WIRE DBL TROC .054X4"
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$7.80
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.00
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.00
|
|
|
K-WIRE DBL TROC .054X4"
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
|
|
K-WIRE DBL TROC .054X6"
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$26.35
|
| Rate for Payer: First Health Commercial |
$27.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.90
|
| Rate for Payer: GEHA Commercial |
$24.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.90
|
| Rate for Payer: Humana ChoiceCare |
$8.06
|
| Rate for Payer: Multiplan All |
$28.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.60
|
| Rate for Payer: OMNI Networks Commercial |
$21.70
|
| Rate for Payer: One Health Plan PPO/POS |
$27.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$29.45
|
| Rate for Payer: Three Rivers Provider Network All |
$23.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$28.83
|
| Rate for Payer: Zelis Auto |
$12.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.50
|
|
|
K-WIRE DBL TROC .054X6"
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.80
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$26.35
|
| Rate for Payer: First Health Commercial |
$27.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.90
|
| Rate for Payer: GEHA Commercial |
$21.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.90
|
| Rate for Payer: Multiplan All |
$28.21
|
| Rate for Payer: OMNI Networks Commercial |
$21.70
|
| Rate for Payer: One Health Plan PPO/POS |
$27.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$29.45
|
| Rate for Payer: Three Rivers Provider Network All |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$28.83
|
| Rate for Payer: Zelis Auto |
$12.40
|
|
|
K-WIRE DBL TROC .054X9"
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: First Health Commercial |
$29.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$29.70
|
| Rate for Payer: GEHA Commercial |
$26.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$29.70
|
| Rate for Payer: Humana ChoiceCare |
$8.58
|
| Rate for Payer: Multiplan All |
$30.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.80
|
| Rate for Payer: OMNI Networks Commercial |
$23.10
|
| Rate for Payer: One Health Plan PPO/POS |
$29.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.35
|
| Rate for Payer: Three Rivers Provider Network All |
$24.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$30.69
|
| Rate for Payer: Zelis Auto |
$13.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.50
|
|
|
K-WIRE DBL TROC .054X9"
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$26.40
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: First Health Commercial |
$29.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$29.70
|
| Rate for Payer: GEHA Commercial |
$23.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$29.70
|
| Rate for Payer: Multiplan All |
$30.03
|
| Rate for Payer: OMNI Networks Commercial |
$23.10
|
| Rate for Payer: One Health Plan PPO/POS |
$29.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.35
|
| Rate for Payer: Three Rivers Provider Network All |
$24.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$30.69
|
| Rate for Payer: Zelis Auto |
$13.20
|
|
|
K-WIRE DBL TROC .062X4"
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$7.80
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.00
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.00
|
|
|
K-WIRE DBL TROC .062X4"
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
|
|
K-WIRE DBL TROC .062X6"
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$26.35
|
| Rate for Payer: First Health Commercial |
$27.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.90
|
| Rate for Payer: GEHA Commercial |
$24.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.90
|
| Rate for Payer: Humana ChoiceCare |
$8.06
|
| Rate for Payer: Multiplan All |
$28.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.60
|
| Rate for Payer: OMNI Networks Commercial |
$21.70
|
| Rate for Payer: One Health Plan PPO/POS |
$27.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$29.45
|
| Rate for Payer: Three Rivers Provider Network All |
$23.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$28.83
|
| Rate for Payer: Zelis Auto |
$12.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.50
|
|
|
K-WIRE DBL TROC .062X6"
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.80
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$26.35
|
| Rate for Payer: First Health Commercial |
$27.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.90
|
| Rate for Payer: GEHA Commercial |
$21.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.90
|
| Rate for Payer: Multiplan All |
$28.21
|
| Rate for Payer: OMNI Networks Commercial |
$21.70
|
| Rate for Payer: One Health Plan PPO/POS |
$27.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$29.45
|
| Rate for Payer: Three Rivers Provider Network All |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$28.83
|
| Rate for Payer: Zelis Auto |
$12.40
|
|
|
K-WIRE DBL TROC .062X9"
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$26.40
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: First Health Commercial |
$29.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$29.70
|
| Rate for Payer: GEHA Commercial |
$23.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$29.70
|
| Rate for Payer: Multiplan All |
$30.03
|
| Rate for Payer: OMNI Networks Commercial |
$23.10
|
| Rate for Payer: One Health Plan PPO/POS |
$29.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.35
|
| Rate for Payer: Three Rivers Provider Network All |
$24.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$30.69
|
| Rate for Payer: Zelis Auto |
$13.20
|
|
|
K-WIRE DBL TROC .062X9"
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: First Health Commercial |
$29.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$29.70
|
| Rate for Payer: GEHA Commercial |
$26.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$29.70
|
| Rate for Payer: Humana ChoiceCare |
$8.58
|
| Rate for Payer: Multiplan All |
$30.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.80
|
| Rate for Payer: OMNI Networks Commercial |
$23.10
|
| Rate for Payer: One Health Plan PPO/POS |
$29.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.35
|
| Rate for Payer: Three Rivers Provider Network All |
$24.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$30.69
|
| Rate for Payer: Zelis Auto |
$13.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.50
|
|
|
LABETALOL HCL 100MG/20ML - MDV
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
NDC 51991093498
|
| Hospital Charge Code |
3370000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$12.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Humana ChoiceCare |
$4.16
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.60
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
LABETALOL HCL 100MG/20ML - MDV
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 51991093498
|
| Hospital Charge Code |
3370000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
