|
IMPLT SCREW 6.5X60MM FULLY THREADED
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002872
|
|
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 6.5X60MM FULLY THREADED
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002872
|
|
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 6.5X65MM
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.50 |
| Max. Negotiated Rate |
$1,020.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cigna Commercial |
$912.90
|
| Rate for Payer: First Health Commercial |
$966.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$966.60
|
| Rate for Payer: GEHA Commercial |
$859.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$966.60
|
| Rate for Payer: Humana ChoiceCare |
$279.24
|
| Rate for Payer: Multiplan All |
$977.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.40
|
| Rate for Payer: OMNI Networks Commercial |
$751.80
|
| Rate for Payer: One Health Plan PPO/POS |
$966.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,020.30
|
| Rate for Payer: Three Rivers Provider Network All |
$805.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$945.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$268.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$998.82
|
| Rate for Payer: Zelis Auto |
$429.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$537.00
|
|
|
IMPLT SCREW 6.5X65MM
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.60 |
| Max. Negotiated Rate |
$1,020.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$859.20
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cigna Commercial |
$912.90
|
| Rate for Payer: First Health Commercial |
$966.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$966.60
|
| Rate for Payer: GEHA Commercial |
$751.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$966.60
|
| Rate for Payer: Multiplan All |
$977.34
|
| Rate for Payer: OMNI Networks Commercial |
$751.80
|
| Rate for Payer: One Health Plan PPO/POS |
$966.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,020.30
|
| Rate for Payer: Three Rivers Provider Network All |
$805.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$998.82
|
| Rate for Payer: Zelis Auto |
$429.60
|
|
|
IMPLT SCREW 6.5X65MM
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000459
|
|
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 6.5X65MM
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000459
|
|
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 6.5X65MM FULLY THREADED
|
Facility
|
IP
|
$1,397.64
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006772
|
|
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
|
|
|
IMPLT SCREW 6.5X65MM FULLY THREADED
|
Facility
|
OP
|
$1,397.64
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.41 |
| Max. Negotiated Rate |
$1,327.76 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$838.58
|
| 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 |
$1,118.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,257.88
|
| Rate for Payer: Humana ChoiceCare |
$363.39
|
| Rate for Payer: Multiplan All |
$1,271.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$838.58
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,229.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$349.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,299.81
|
| Rate for Payer: Zelis Auto |
$559.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$698.82
|
|
|
IMPLT SCREW 6.5X70MM
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000460
|
|
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 6.5X70MM
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000460
|
|
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 6.5X70MM
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000716
|
|
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 6.5X70MM
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000716
|
|
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 6.5X70MM FULLY THREADED
|
Facility
|
IP
|
$1,397.64
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006771
|
|
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
|
|
|
IMPLT SCREW 6.5X70MM FULLY THREADED
|
Facility
|
OP
|
$1,397.64
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.41 |
| Max. Negotiated Rate |
$1,327.76 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$838.58
|
| 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 |
$1,118.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,257.88
|
| Rate for Payer: Humana ChoiceCare |
$363.39
|
| Rate for Payer: Multiplan All |
$1,271.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$838.58
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,229.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$349.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,299.81
|
| Rate for Payer: Zelis Auto |
$559.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$698.82
|
|
|
IMPLT SCREW 6.5X75
|
Facility
|
IP
|
$1,194.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.60 |
| Max. Negotiated Rate |
$1,134.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$955.20
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cigna Commercial |
$1,014.90
|
| Rate for Payer: First Health Commercial |
$1,074.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,074.60
|
| Rate for Payer: GEHA Commercial |
$835.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,074.60
|
| Rate for Payer: Multiplan All |
$1,086.54
|
| Rate for Payer: OMNI Networks Commercial |
$835.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,074.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,134.30
|
| Rate for Payer: Three Rivers Provider Network All |
$895.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,110.42
|
| Rate for Payer: Zelis Auto |
$477.60
|
|
|
IMPLT SCREW 6.5X75
|
Facility
|
OP
|
$1,194.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.50 |
| Max. Negotiated Rate |
$1,134.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$716.40
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cigna Commercial |
$1,014.90
|
| Rate for Payer: First Health Commercial |
$1,074.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,074.60
|
| Rate for Payer: GEHA Commercial |
$955.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,074.60
|
| Rate for Payer: Humana ChoiceCare |
$310.44
|
| Rate for Payer: Multiplan All |
$1,086.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$716.40
|
| Rate for Payer: OMNI Networks Commercial |
$835.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,074.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,134.30
|
| Rate for Payer: Three Rivers Provider Network All |
$895.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,050.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$298.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,110.42
|
| Rate for Payer: Zelis Auto |
$477.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$597.00
|
|
|
IMPLT SCREW 6.5X75MM
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.50 |
| Max. Negotiated Rate |
$1,020.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cigna Commercial |
$912.90
|
| Rate for Payer: First Health Commercial |
$966.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$966.60
|
| Rate for Payer: GEHA Commercial |
$859.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$966.60
|
| Rate for Payer: Humana ChoiceCare |
$279.24
|
| Rate for Payer: Multiplan All |
$977.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.40
|
| Rate for Payer: OMNI Networks Commercial |
$751.80
|
| Rate for Payer: One Health Plan PPO/POS |
$966.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,020.30
|
| Rate for Payer: Three Rivers Provider Network All |
$805.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$945.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$268.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$998.82
|
| Rate for Payer: Zelis Auto |
$429.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$537.00
|
|
|
IMPLT SCREW 6.5X75MM
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000718
|
|
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 6.5X75MM
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000718
|
|
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 6.5X75MM
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.60 |
| Max. Negotiated Rate |
$1,020.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$859.20
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cigna Commercial |
$912.90
|
| Rate for Payer: First Health Commercial |
$966.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$966.60
|
| Rate for Payer: GEHA Commercial |
$751.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$966.60
|
| Rate for Payer: Multiplan All |
$977.34
|
| Rate for Payer: OMNI Networks Commercial |
$751.80
|
| Rate for Payer: One Health Plan PPO/POS |
$966.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,020.30
|
| Rate for Payer: Three Rivers Provider Network All |
$805.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$998.82
|
| Rate for Payer: Zelis Auto |
$429.60
|
|
|
IMPLT SCREW 6.5X75MM
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000709
|
|
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 6.5X75MM
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000709
|
|
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 6.5X80
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000719
|
|
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 6.5X80
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000719
|
|
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 6.5X80MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
