|
IMPLT SCREW BONE 4.0X26MM
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$775.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Humana ChoiceCare |
$251.94
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$581.40
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$852.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$484.50
|
|
|
IMPLT SCREW BONE 4.0X28MM
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$775.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Humana ChoiceCare |
$251.94
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$581.40
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$852.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$484.50
|
|
|
IMPLT SCREW BONE 4.0X28MM
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$775.20
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$678.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
|
|
IMPLT SCREW BONE 4.0X30MM
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$775.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Humana ChoiceCare |
$251.94
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$581.40
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$852.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$484.50
|
|
|
IMPLT SCREW BONE 4.0X30MM
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$775.20
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$678.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
|
|
IMPLT SCREW BONE 4.0X32MM
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$775.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Humana ChoiceCare |
$251.94
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$581.40
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$852.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$484.50
|
|
|
IMPLT SCREW BONE 4.0X32MM
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$775.20
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$678.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
|
|
IMPLT SCREW BONE 4.0X34MM
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$775.20
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$678.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
|
|
IMPLT SCREW BONE 4.0X34MM
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$775.20
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$678.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
|
|
IMPLT SCREW BONE 4.0X34MM
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$775.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Humana ChoiceCare |
$251.94
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$581.40
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$852.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$484.50
|
|
|
IMPLT SCREW BONE 4.0X34MM
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$775.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Humana ChoiceCare |
$251.94
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$581.40
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$852.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$484.50
|
|
|
IMPLT SCREW BONE 4.0X36MM
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$775.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Humana ChoiceCare |
$251.94
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$581.40
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$852.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$484.50
|
|
|
IMPLT SCREW BONE 4.0X36MM
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$775.20
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$678.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
|
|
IMPLT SCREW BONE 4.0X38MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW BONE 4.0X38MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW BONE 4.0X40MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW BONE 4.0X40MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW BONE 4.0X42MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW BONE 4.0X42MM
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$775.20
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$678.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
|
|
IMPLT SCREW BONE 4.0X42MM
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$775.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Humana ChoiceCare |
$251.94
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$581.40
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$852.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$484.50
|
|
|
IMPLT SCREW BONE 4.0X42MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW BONE 4.0X44MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW BONE 4.0X44MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW BONE 4.0X46MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW BONE 4.0X46MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
