|
IMPLT SCREW 5.0X65MM
|
Facility
|
OP
|
$873.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$218.25 |
| Max. Negotiated Rate |
$829.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$742.05
|
| Rate for Payer: First Health Commercial |
$785.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$785.70
|
| Rate for Payer: GEHA Commercial |
$698.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$785.70
|
| Rate for Payer: Humana ChoiceCare |
$226.98
|
| Rate for Payer: Multiplan All |
$794.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$523.80
|
| Rate for Payer: OMNI Networks Commercial |
$611.10
|
| Rate for Payer: One Health Plan PPO/POS |
$785.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$829.35
|
| Rate for Payer: Three Rivers Provider Network All |
$654.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$768.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$218.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$811.89
|
| Rate for Payer: Zelis Auto |
$349.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$436.50
|
|
|
IMPLT SCREW 5.0X65MM
|
Facility
|
IP
|
$873.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.20 |
| Max. Negotiated Rate |
$829.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$698.40
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$742.05
|
| Rate for Payer: First Health Commercial |
$785.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$785.70
|
| Rate for Payer: GEHA Commercial |
$611.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$785.70
|
| Rate for Payer: Multiplan All |
$794.43
|
| Rate for Payer: OMNI Networks Commercial |
$611.10
|
| Rate for Payer: One Health Plan PPO/POS |
$785.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$829.35
|
| Rate for Payer: Three Rivers Provider Network All |
$654.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$811.89
|
| Rate for Payer: Zelis Auto |
$349.20
|
|
|
IMPLT SCREW 55MM FRAG SMALL
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$704.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Humana ChoiceCare |
$229.06
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$528.60
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$775.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$440.50
|
|
|
IMPLT SCREW 55MM FRAG SMALL
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$704.80
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$616.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
|
|
IMPLT SCREW 60MM FRAG SMALL
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$249.90
|
| Rate for Payer: First Health Commercial |
$264.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$264.60
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$264.60
|
| Rate for Payer: Humana ChoiceCare |
$76.44
|
| Rate for Payer: Multiplan All |
$267.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$176.40
|
| Rate for Payer: OMNI Networks Commercial |
$205.80
|
| Rate for Payer: One Health Plan PPO/POS |
$264.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$279.30
|
| Rate for Payer: Three Rivers Provider Network All |
$220.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$258.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$273.42
|
| Rate for Payer: Zelis Auto |
$117.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$147.00
|
|
|
IMPLT SCREW 60MM FRAG SMALL
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.20
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$249.90
|
| Rate for Payer: First Health Commercial |
$264.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$264.60
|
| Rate for Payer: GEHA Commercial |
$205.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$264.60
|
| Rate for Payer: Multiplan All |
$267.54
|
| Rate for Payer: OMNI Networks Commercial |
$205.80
|
| Rate for Payer: One Health Plan PPO/POS |
$264.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$279.30
|
| Rate for Payer: Three Rivers Provider Network All |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$273.42
|
| Rate for Payer: Zelis Auto |
$117.60
|
|
|
IMPLT SCREW 6.0X40MM
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$298.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Humana ChoiceCare |
$96.98
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$223.80
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$328.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$93.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$186.50
|
|
|
IMPLT SCREW 6.0X40MM
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.40
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$261.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
|
|
IMPLT SCREW 6.0X45MM
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.80 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$293.60
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$311.95
|
| Rate for Payer: First Health Commercial |
$330.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$330.30
|
| Rate for Payer: GEHA Commercial |
$256.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$330.30
|
| Rate for Payer: Multiplan All |
$333.97
|
| Rate for Payer: OMNI Networks Commercial |
$256.90
|
| Rate for Payer: One Health Plan PPO/POS |
$330.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$348.65
|
| Rate for Payer: Three Rivers Provider Network All |
$275.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$341.31
|
| Rate for Payer: Zelis Auto |
$146.80
|
|
|
IMPLT SCREW 6.0X45MM
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.75 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$311.95
|
| Rate for Payer: First Health Commercial |
$330.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$330.30
|
| Rate for Payer: GEHA Commercial |
$293.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$330.30
|
| Rate for Payer: Humana ChoiceCare |
$95.42
|
| Rate for Payer: Multiplan All |
$333.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$220.20
|
| Rate for Payer: OMNI Networks Commercial |
$256.90
|
| Rate for Payer: One Health Plan PPO/POS |
$330.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$348.65
|
| Rate for Payer: Three Rivers Provider Network All |
$275.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$322.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$341.31
|
| Rate for Payer: Zelis Auto |
$146.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.50
|
|
|
IMPLT SCREW 6.0X50MM
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$298.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Humana ChoiceCare |
$96.98
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$223.80
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$328.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$93.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$186.50
|
|
|
IMPLT SCREW 6.0X50MM
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.40
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$261.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
|
|
IMPLT SCREW 6.0X55MM
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$298.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Humana ChoiceCare |
$96.98
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$223.80
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$328.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$93.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$186.50
|
|
|
IMPLT SCREW 6.0X55MM
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.40
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$261.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
|
|
IMPLT SCREW 6.5MMX60MM
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.60 |
| Max. Negotiated Rate |
$1,300.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,095.20
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$958.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| Rate for Payer: Multiplan All |
$1,245.79
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,300.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.17
|
| Rate for Payer: Zelis Auto |
$547.60
|
|
|
IMPLT SCREW 6.5MMX60MM
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$342.25 |
| Max. Negotiated Rate |
$1,300.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$1,095.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| Rate for Payer: Humana ChoiceCare |
$355.94
|
| Rate for Payer: Multiplan All |
$1,245.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$821.40
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,300.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,204.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$342.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.17
|
| Rate for Payer: Zelis Auto |
$547.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$684.50
|
|
|
IMPLT SCREW 6.5MMX65MM
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.60 |
| Max. Negotiated Rate |
$1,300.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,095.20
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$958.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| Rate for Payer: Multiplan All |
$1,245.79
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,300.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.17
|
| Rate for Payer: Zelis Auto |
$547.60
|
|
|
IMPLT SCREW 6.5MMX65MM
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$342.25 |
| Max. Negotiated Rate |
$1,300.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$1,095.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| Rate for Payer: Humana ChoiceCare |
$355.94
|
| Rate for Payer: Multiplan All |
$1,245.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$821.40
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,300.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,204.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$342.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.17
|
| Rate for Payer: Zelis Auto |
$547.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$684.50
|
|
|
IMPLT SCREW 6.5MMX75MM
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.60 |
| Max. Negotiated Rate |
$1,300.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,095.20
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$958.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| Rate for Payer: Multiplan All |
$1,245.79
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,300.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.17
|
| Rate for Payer: Zelis Auto |
$547.60
|
|
|
IMPLT SCREW 6.5MMX75MM
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$342.25 |
| Max. Negotiated Rate |
$1,300.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$1,095.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| Rate for Payer: Humana ChoiceCare |
$355.94
|
| Rate for Payer: Multiplan All |
$1,245.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$821.40
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,300.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,204.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$342.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.17
|
| Rate for Payer: Zelis Auto |
$547.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$684.50
|
|
|
IMPLT SCREW 6.5X100MM
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.00 |
| Max. Negotiated Rate |
$1,135.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$956.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cigna Commercial |
$1,015.75
|
| Rate for Payer: First Health Commercial |
$1,075.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,075.50
|
| Rate for Payer: GEHA Commercial |
$836.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,075.50
|
| Rate for Payer: Multiplan All |
$1,087.45
|
| Rate for Payer: OMNI Networks Commercial |
$836.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,075.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,135.25
|
| Rate for Payer: Three Rivers Provider Network All |
$896.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,111.35
|
| Rate for Payer: Zelis Auto |
$478.00
|
|
|
IMPLT SCREW 6.5X100MM
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.75 |
| Max. Negotiated Rate |
$1,135.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$717.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cigna Commercial |
$1,015.75
|
| Rate for Payer: First Health Commercial |
$1,075.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,075.50
|
| Rate for Payer: GEHA Commercial |
$956.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,075.50
|
| Rate for Payer: Humana ChoiceCare |
$310.70
|
| Rate for Payer: Multiplan All |
$1,087.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$717.00
|
| Rate for Payer: OMNI Networks Commercial |
$836.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,075.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,135.25
|
| Rate for Payer: Three Rivers Provider Network All |
$896.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,051.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$298.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,111.35
|
| Rate for Payer: Zelis Auto |
$478.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$597.50
|
|
|
IMPLT SCREW 6.5X100MM
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.60 |
| Max. Negotiated Rate |
$1,300.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,095.20
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$958.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| Rate for Payer: Multiplan All |
$1,245.79
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,300.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.17
|
| Rate for Payer: Zelis Auto |
$547.60
|
|
|
IMPLT SCREW 6.5X100MM
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$342.25 |
| Max. Negotiated Rate |
$1,300.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$1,095.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| Rate for Payer: Humana ChoiceCare |
$355.94
|
| Rate for Payer: Multiplan All |
$1,245.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$821.40
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,300.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,204.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$342.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.17
|
| Rate for Payer: Zelis Auto |
$547.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$684.50
|
|
|
IMPLT SCREW 6.5X105MM
|
Facility
|
IP
|
$1,397.64
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.06 |
| Max. Negotiated Rate |
$1,327.76 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,118.11
|
| Rate for Payer: Cash Price |
$838.58
|
| Rate for Payer: Cash Price |
$838.58
|
| Rate for Payer: Cigna Commercial |
$1,187.99
|
| Rate for Payer: First Health Commercial |
$1,257.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,257.88
|
| Rate for Payer: GEHA Commercial |
$978.35
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,257.88
|
| Rate for Payer: Multiplan All |
$1,271.85
|
| Rate for Payer: OMNI Networks Commercial |
$978.35
|
| Rate for Payer: One Health Plan PPO/POS |
$1,257.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,327.76
|
| Rate for Payer: Three Rivers Provider Network All |
$1,048.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,299.81
|
| Rate for Payer: Zelis Auto |
$559.06
|
|
