|
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
|
|
|
IMPLT SCREW 6.5X85
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003420
|
|
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 6.5X85
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003420
|
|
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 6.5X85MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| 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 |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW 6.5X85MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000721
|
|
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
|
|
|
IMPLT SCREW 6.5X85MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001352
|
|
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
|
|
|
IMPLT SCREW 6.5X85MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| 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 |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW 6.5X90MM
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000710
|
|
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 6.5X90MM
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000710
|
|
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 6.5X90MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| 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 |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW 6.5X90MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001355
|
|
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
|
|
|
IMPLT SCREW 6.5X90MM
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006582
|
|
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 6.5X90MM
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006582
|
|
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 6.5X95MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002931
|
|
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
|
|
|
IMPLT SCREW 6.5X95MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002931
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| 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 |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW 6.5X95MM
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006581
|
|
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 6.5X95MM
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006581
|
|
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 7.0 X 75MM SHORT THREAD
|
Facility
|
IP
|
$1,577.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.80 |
| Max. Negotiated Rate |
$1,498.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,261.60
|
| Rate for Payer: Cash Price |
$946.20
|
| Rate for Payer: Cash Price |
$946.20
|
| Rate for Payer: Cigna Commercial |
$1,340.45
|
| Rate for Payer: First Health Commercial |
$1,419.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,419.30
|
| Rate for Payer: GEHA Commercial |
$1,103.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,419.30
|
| Rate for Payer: Multiplan All |
$1,435.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,103.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,419.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,498.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,182.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,466.61
|
| Rate for Payer: Zelis Auto |
$630.80
|
|
|
IMPLT SCREW 7.0 X 75MM SHORT THREAD
|
Facility
|
OP
|
$1,577.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.25 |
| Max. Negotiated Rate |
$1,498.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$946.20
|
| Rate for Payer: Cash Price |
$946.20
|
| Rate for Payer: Cash Price |
$946.20
|
| Rate for Payer: Cigna Commercial |
$1,340.45
|
| Rate for Payer: First Health Commercial |
$1,419.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,419.30
|
| Rate for Payer: GEHA Commercial |
$1,261.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,419.30
|
| Rate for Payer: Humana ChoiceCare |
$410.02
|
| Rate for Payer: Multiplan All |
$1,435.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$946.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,103.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,419.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,498.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,182.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,387.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$394.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,466.61
|
| Rate for Payer: Zelis Auto |
$630.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$788.50
|
|
|
IMPLT SCREW 7.0 X 80MM SHORT THREAD
|
Facility
|
IP
|
$1,512.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.80 |
| Max. Negotiated Rate |
$1,436.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,209.60
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cigna Commercial |
$1,285.20
|
| Rate for Payer: First Health Commercial |
$1,360.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,360.80
|
| Rate for Payer: GEHA Commercial |
$1,058.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,360.80
|
| Rate for Payer: Multiplan All |
$1,375.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,058.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,360.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,436.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,134.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,406.16
|
| Rate for Payer: Zelis Auto |
$604.80
|
|
|
IMPLT SCREW 7.0 X 80MM SHORT THREAD
|
Facility
|
OP
|
$1,512.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$1,436.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cigna Commercial |
$1,285.20
|
| Rate for Payer: First Health Commercial |
$1,360.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,360.80
|
| Rate for Payer: GEHA Commercial |
$1,209.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,360.80
|
| Rate for Payer: Humana ChoiceCare |
$393.12
|
| Rate for Payer: Multiplan All |
$1,375.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$907.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,058.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,360.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,436.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,134.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,330.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$378.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,406.16
|
| Rate for Payer: Zelis Auto |
$604.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$756.00
|
|
|
IMPLT SCREW 8.0MM 85MM 25MM ANSIS 3
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.50 |
| Max. Negotiated Rate |
$1,153.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$728.40
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cigna Commercial |
$1,031.90
|
| Rate for Payer: First Health Commercial |
$1,092.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,092.60
|
| Rate for Payer: GEHA Commercial |
$971.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,092.60
|
| Rate for Payer: Humana ChoiceCare |
$315.64
|
| Rate for Payer: Multiplan All |
$1,104.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$728.40
|
| Rate for Payer: OMNI Networks Commercial |
$849.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,092.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,153.30
|
| Rate for Payer: Three Rivers Provider Network All |
$910.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,068.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$303.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,129.02
|
| Rate for Payer: Zelis Auto |
$485.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$607.00
|
|
|
IMPLT SCREW 8.0MM 85MM 25MM ANSIS 3
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.60 |
| Max. Negotiated Rate |
$1,153.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$971.20
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cigna Commercial |
$1,031.90
|
| Rate for Payer: First Health Commercial |
$1,092.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,092.60
|
| Rate for Payer: GEHA Commercial |
$849.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,092.60
|
| Rate for Payer: Multiplan All |
$1,104.74
|
| Rate for Payer: OMNI Networks Commercial |
$849.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,092.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,153.30
|
| Rate for Payer: Three Rivers Provider Network All |
$910.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,129.02
|
| Rate for Payer: Zelis Auto |
$485.60
|
|
|
IMPLT SCREW 8.0X50MM
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.25 |
| Max. Negotiated Rate |
$1,159.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna Commercial |
$1,037.85
|
| Rate for Payer: First Health Commercial |
$1,098.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,098.90
|
| Rate for Payer: GEHA Commercial |
$976.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,098.90
|
| Rate for Payer: Humana ChoiceCare |
$317.46
|
| Rate for Payer: Multiplan All |
$1,111.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$732.60
|
| Rate for Payer: OMNI Networks Commercial |
$854.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,098.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,159.95
|
| Rate for Payer: Three Rivers Provider Network All |
$915.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,074.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$305.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,135.53
|
| Rate for Payer: Zelis Auto |
$488.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$610.50
|
|
|
IMPLT SCREW 8.0X50MM
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$1,159.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$976.80
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna Commercial |
$1,037.85
|
| Rate for Payer: First Health Commercial |
$1,098.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,098.90
|
| Rate for Payer: GEHA Commercial |
$854.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,098.90
|
| Rate for Payer: Multiplan All |
$1,111.11
|
| Rate for Payer: OMNI Networks Commercial |
$854.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,098.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,159.95
|
| Rate for Payer: Three Rivers Provider Network All |
$915.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,135.53
|
| Rate for Payer: Zelis Auto |
$488.40
|
|
