|
IMPLT ROD 8MM X 350MM
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.80 |
| Max. Negotiated Rate |
$1,398.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,177.60
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$1,251.20
|
| Rate for Payer: First Health Commercial |
$1,324.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,324.80
|
| Rate for Payer: GEHA Commercial |
$1,030.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,324.80
|
| Rate for Payer: Multiplan All |
$1,339.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,030.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,324.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,398.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.96
|
| Rate for Payer: Zelis Auto |
$588.80
|
|
|
IMPLT ROD ANGLE 30 DEGREE
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.75 |
| Max. Negotiated Rate |
$610.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$546.55
|
| Rate for Payer: First Health Commercial |
$578.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$578.70
|
| Rate for Payer: GEHA Commercial |
$514.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$578.70
|
| Rate for Payer: Humana ChoiceCare |
$167.18
|
| Rate for Payer: Multiplan All |
$585.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$385.80
|
| Rate for Payer: OMNI Networks Commercial |
$450.10
|
| Rate for Payer: One Health Plan PPO/POS |
$578.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$610.85
|
| Rate for Payer: Three Rivers Provider Network All |
$482.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$565.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$160.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$597.99
|
| Rate for Payer: Zelis Auto |
$257.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$321.50
|
|
|
IMPLT ROD ANGLE 30 DEGREE
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.20 |
| Max. Negotiated Rate |
$610.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$514.40
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$546.55
|
| Rate for Payer: First Health Commercial |
$578.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$578.70
|
| Rate for Payer: GEHA Commercial |
$450.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$578.70
|
| Rate for Payer: Multiplan All |
$585.13
|
| Rate for Payer: OMNI Networks Commercial |
$450.10
|
| Rate for Payer: One Health Plan PPO/POS |
$578.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$610.85
|
| Rate for Payer: Three Rivers Provider Network All |
$482.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$597.99
|
| Rate for Payer: Zelis Auto |
$257.20
|
|
|
IMPLT ROD CONNECTING 3X40MM
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$414.40
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$440.30
|
| Rate for Payer: First Health Commercial |
$466.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$466.20
|
| Rate for Payer: GEHA Commercial |
$362.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$466.20
|
| Rate for Payer: Multiplan All |
$471.38
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: One Health Plan PPO/POS |
$466.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$492.10
|
| Rate for Payer: Three Rivers Provider Network All |
$388.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$481.74
|
| Rate for Payer: Zelis Auto |
$207.20
|
|
|
IMPLT ROD CONNECTING 3X40MM
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$440.30
|
| Rate for Payer: First Health Commercial |
$466.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$466.20
|
| Rate for Payer: GEHA Commercial |
$414.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$466.20
|
| Rate for Payer: Humana ChoiceCare |
$134.68
|
| Rate for Payer: Multiplan All |
$471.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$310.80
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: One Health Plan PPO/POS |
$466.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$492.10
|
| Rate for Payer: Three Rivers Provider Network All |
$388.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$455.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$129.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$481.74
|
| Rate for Payer: Zelis Auto |
$207.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$259.00
|
|
|
IMPLT ROD CONNECTING FIBER CARBON 8X100
|
Facility
|
OP
|
$1,407.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90062139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,336.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$1,195.95
|
| Rate for Payer: First Health Commercial |
$1,266.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,266.30
|
| Rate for Payer: GEHA Commercial |
$1,125.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,266.30
|
| Rate for Payer: Humana ChoiceCare |
$365.82
|
| Rate for Payer: Multiplan All |
$1,280.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$844.20
|
| Rate for Payer: OMNI Networks Commercial |
$984.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,266.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,336.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,055.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,238.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,308.51
|
| Rate for Payer: Zelis Auto |
$562.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$703.50
|
|
|
IMPLT ROD CONNECTING FIBER CARBON 8X100
|
Facility
|
IP
|
$1,407.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90062139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.80 |
| Max. Negotiated Rate |
$1,336.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,125.60
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$1,195.95
|
| Rate for Payer: First Health Commercial |
$1,266.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,266.30
|
| Rate for Payer: GEHA Commercial |
$984.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,266.30
|
| Rate for Payer: Multiplan All |
$1,280.37
|
| Rate for Payer: OMNI Networks Commercial |
$984.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,266.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,336.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,055.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,308.51
|
| Rate for Payer: Zelis Auto |
$562.80
|
|
|
IMPLT ROD CONNECTING FIBER CARBON 8X100
|
Facility
|
IP
|
$1,407.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.80 |
| Max. Negotiated Rate |
$1,336.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,125.60
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$1,195.95
|
| Rate for Payer: First Health Commercial |
$1,266.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,266.30
|
| Rate for Payer: GEHA Commercial |
$984.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,266.30
|
| Rate for Payer: Multiplan All |
$1,280.37
|
| Rate for Payer: OMNI Networks Commercial |
$984.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,266.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,336.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,055.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,308.51
|
| Rate for Payer: Zelis Auto |
$562.80
|
|
|
IMPLT ROD CONNECTING FIBER CARBON 8X100
|
Facility
|
OP
|
$1,407.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,336.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$1,195.95
|
| Rate for Payer: First Health Commercial |
$1,266.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,266.30
|
| Rate for Payer: GEHA Commercial |
$1,125.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,266.30
|
| Rate for Payer: Humana ChoiceCare |
$365.82
|
| Rate for Payer: Multiplan All |
$1,280.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$844.20
|
| Rate for Payer: OMNI Networks Commercial |
$984.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,266.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,336.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,055.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,238.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,308.51
|
| Rate for Payer: Zelis Auto |
$562.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$703.50
|
|
|
IMPLT ROD CONNECTING FIBER CARBON 8X300
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.80 |
| Max. Negotiated Rate |
$1,398.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,177.60
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$1,251.20
|
| Rate for Payer: First Health Commercial |
$1,324.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,324.80
|
| Rate for Payer: GEHA Commercial |
$1,030.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,324.80
|
| Rate for Payer: Multiplan All |
$1,339.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,030.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,324.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,398.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.96
|
| Rate for Payer: Zelis Auto |
$588.80
|
|
|
IMPLT ROD CONNECTING FIBER CARBON 8X300
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.00 |
| Max. Negotiated Rate |
$1,398.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$1,251.20
|
| Rate for Payer: First Health Commercial |
$1,324.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,324.80
|
| Rate for Payer: GEHA Commercial |
$1,177.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,324.80
|
| Rate for Payer: Humana ChoiceCare |
$382.72
|
| Rate for Payer: Multiplan All |
$1,339.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$883.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,030.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,324.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,398.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,295.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$368.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.96
|
| Rate for Payer: Zelis Auto |
$588.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$736.00
|
|
|
IMPLT ROD FIBER CARBON 3X120MM
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$213.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Humana ChoiceCare |
$69.42
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$160.20
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$234.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$133.50
|
|
|
IMPLT ROD FIBER CARBON 3X120MM
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.60
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$186.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
|
|
IMPLT ROD FIBER CARBON 3X150MM
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$213.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Humana ChoiceCare |
$69.42
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$160.20
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$234.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$133.50
|
|
|
IMPLT ROD FIBER CARBON 3X150MM
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.60
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$186.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
|
|
IMPLT ROD SEMI CIRCULAR 8MM X 174MM
|
Facility
|
IP
|
$1,379.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.60 |
| Max. Negotiated Rate |
$1,310.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,103.20
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cigna Commercial |
$1,172.15
|
| Rate for Payer: First Health Commercial |
$1,241.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,241.10
|
| Rate for Payer: GEHA Commercial |
$965.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,241.10
|
| Rate for Payer: Multiplan All |
$1,254.89
|
| Rate for Payer: OMNI Networks Commercial |
$965.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,241.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,310.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,034.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,282.47
|
| Rate for Payer: Zelis Auto |
$551.60
|
|
|
IMPLT ROD SEMI CIRCULAR 8MM X 174MM
|
Facility
|
OP
|
$1,379.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.75 |
| Max. Negotiated Rate |
$1,310.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$827.40
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cigna Commercial |
$1,172.15
|
| Rate for Payer: First Health Commercial |
$1,241.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,241.10
|
| Rate for Payer: GEHA Commercial |
$1,103.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,241.10
|
| Rate for Payer: Humana ChoiceCare |
$358.54
|
| Rate for Payer: Multiplan All |
$1,254.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$827.40
|
| Rate for Payer: OMNI Networks Commercial |
$965.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,241.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,310.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,034.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,213.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$344.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,282.47
|
| Rate for Payer: Zelis Auto |
$551.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$689.50
|
|
|
IMPLT ROD THREADED M4 1806-6138
|
Facility
|
OP
|
$991.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.75 |
| Max. Negotiated Rate |
$941.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$594.60
|
| Rate for Payer: Cash Price |
$594.60
|
| Rate for Payer: Cash Price |
$594.60
|
| Rate for Payer: Cigna Commercial |
$842.35
|
| Rate for Payer: First Health Commercial |
$891.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.90
|
| Rate for Payer: GEHA Commercial |
$792.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.90
|
| Rate for Payer: Humana ChoiceCare |
$257.66
|
| Rate for Payer: Multiplan All |
$901.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$594.60
|
| Rate for Payer: OMNI Networks Commercial |
$693.70
|
| Rate for Payer: One Health Plan PPO/POS |
$891.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$941.45
|
| Rate for Payer: Three Rivers Provider Network All |
$743.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$247.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$921.63
|
| Rate for Payer: Zelis Auto |
$396.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$495.50
|
|
|
IMPLT ROD THREADED M4 1806-6138
|
Facility
|
IP
|
$991.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$396.40 |
| Max. Negotiated Rate |
$941.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$792.80
|
| Rate for Payer: Cash Price |
$594.60
|
| Rate for Payer: Cash Price |
$594.60
|
| Rate for Payer: Cigna Commercial |
$842.35
|
| Rate for Payer: First Health Commercial |
$891.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.90
|
| Rate for Payer: GEHA Commercial |
$693.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.90
|
| Rate for Payer: Multiplan All |
$901.81
|
| Rate for Payer: OMNI Networks Commercial |
$693.70
|
| Rate for Payer: One Health Plan PPO/POS |
$891.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$941.45
|
| Rate for Payer: Three Rivers Provider Network All |
$743.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$921.63
|
| Rate for Payer: Zelis Auto |
$396.40
|
|
|
IMPLT ROD THREADED M7 1806-6136
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.25 |
| Max. Negotiated Rate |
$1,019.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$643.80
|
| Rate for Payer: Cash Price |
$643.80
|
| Rate for Payer: Cash Price |
$643.80
|
| Rate for Payer: Cigna Commercial |
$912.05
|
| Rate for Payer: First Health Commercial |
$965.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$965.70
|
| Rate for Payer: GEHA Commercial |
$858.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$965.70
|
| Rate for Payer: Humana ChoiceCare |
$278.98
|
| Rate for Payer: Multiplan All |
$976.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$643.80
|
| Rate for Payer: OMNI Networks Commercial |
$751.10
|
| Rate for Payer: One Health Plan PPO/POS |
$965.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,019.35
|
| Rate for Payer: Three Rivers Provider Network All |
$804.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$944.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$268.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$997.89
|
| Rate for Payer: Zelis Auto |
$429.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$536.50
|
|
|
IMPLT ROD THREADED M7 1806-6136
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.20 |
| Max. Negotiated Rate |
$1,019.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$858.40
|
| Rate for Payer: Cash Price |
$643.80
|
| Rate for Payer: Cash Price |
$643.80
|
| Rate for Payer: Cigna Commercial |
$912.05
|
| Rate for Payer: First Health Commercial |
$965.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$965.70
|
| Rate for Payer: GEHA Commercial |
$751.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$965.70
|
| Rate for Payer: Multiplan All |
$976.43
|
| Rate for Payer: OMNI Networks Commercial |
$751.10
|
| Rate for Payer: One Health Plan PPO/POS |
$965.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,019.35
|
| Rate for Payer: Three Rivers Provider Network All |
$804.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$997.89
|
| Rate for Payer: Zelis Auto |
$429.20
|
|
|
IMPLT ROD TO ROD 3MM
|
Facility
|
OP
|
$2,488.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.00 |
| Max. Negotiated Rate |
$2,363.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,492.80
|
| Rate for Payer: Cash Price |
$1,492.80
|
| Rate for Payer: Cash Price |
$1,492.80
|
| Rate for Payer: Cigna Commercial |
$2,114.80
|
| Rate for Payer: First Health Commercial |
$2,239.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,239.20
|
| Rate for Payer: GEHA Commercial |
$1,990.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,239.20
|
| Rate for Payer: Humana ChoiceCare |
$646.88
|
| Rate for Payer: Multiplan All |
$2,264.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,492.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,741.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,239.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,363.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,866.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,189.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,313.84
|
| Rate for Payer: Zelis Auto |
$995.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,244.00
|
|
|
IMPLT ROD TO ROD 3MM
|
Facility
|
IP
|
$2,488.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.20 |
| Max. Negotiated Rate |
$2,363.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,990.40
|
| Rate for Payer: Cash Price |
$1,492.80
|
| Rate for Payer: Cash Price |
$1,492.80
|
| Rate for Payer: Cigna Commercial |
$2,114.80
|
| Rate for Payer: First Health Commercial |
$2,239.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,239.20
|
| Rate for Payer: GEHA Commercial |
$1,741.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,239.20
|
| Rate for Payer: Multiplan All |
$2,264.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,741.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,239.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,363.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,866.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,313.84
|
| Rate for Payer: Zelis Auto |
$995.20
|
|
|
IMPLT ROD UNIVERSAL 1806-0110
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$385.60 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$771.20
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$674.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: Zelis Auto |
$385.60
|
|
|
IMPLT ROD UNIVERSAL 1806-0110
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.00 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$771.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Humana ChoiceCare |
$250.64
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$578.40
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$241.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$482.00
|
|
