|
IMPLT SCREW CANCELLOUS PINNACLE 6.5X20MM
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.75 |
| Max. Negotiated Rate |
$846.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna Commercial |
$757.35
|
| Rate for Payer: First Health Commercial |
$801.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$801.90
|
| Rate for Payer: GEHA Commercial |
$712.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$801.90
|
| Rate for Payer: Humana ChoiceCare |
$231.66
|
| Rate for Payer: Multiplan All |
$810.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$534.60
|
| Rate for Payer: OMNI Networks Commercial |
$623.70
|
| Rate for Payer: One Health Plan PPO/POS |
$801.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$846.45
|
| Rate for Payer: Three Rivers Provider Network All |
$668.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$784.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$222.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$828.63
|
| Rate for Payer: Zelis Auto |
$356.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$445.50
|
|
|
IMPLT SCREW CANCELLOUS PINNACLE 6.5X20MM
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$356.40 |
| Max. Negotiated Rate |
$846.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$712.80
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna Commercial |
$757.35
|
| Rate for Payer: First Health Commercial |
$801.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$801.90
|
| Rate for Payer: GEHA Commercial |
$623.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$801.90
|
| Rate for Payer: Multiplan All |
$810.81
|
| Rate for Payer: OMNI Networks Commercial |
$623.70
|
| Rate for Payer: One Health Plan PPO/POS |
$801.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$846.45
|
| Rate for Payer: Three Rivers Provider Network All |
$668.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$828.63
|
| Rate for Payer: Zelis Auto |
$356.40
|
|
|
IMPLT SCREW CANCELLOUS P/T 4.0X18MM
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.75 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cigna Commercial |
$179.35
|
| Rate for Payer: First Health Commercial |
$189.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.90
|
| Rate for Payer: GEHA Commercial |
$168.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.90
|
| Rate for Payer: Humana ChoiceCare |
$54.86
|
| Rate for Payer: Multiplan All |
$192.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$126.60
|
| Rate for Payer: OMNI Networks Commercial |
$147.70
|
| Rate for Payer: One Health Plan PPO/POS |
$189.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$200.45
|
| Rate for Payer: Three Rivers Provider Network All |
$158.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$185.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$52.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$196.23
|
| Rate for Payer: Zelis Auto |
$84.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.50
|
|
|
IMPLT SCREW CANCELLOUS P/T 4.0X18MM
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.80
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cigna Commercial |
$179.35
|
| Rate for Payer: First Health Commercial |
$189.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.90
|
| Rate for Payer: GEHA Commercial |
$147.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.90
|
| Rate for Payer: Multiplan All |
$192.01
|
| Rate for Payer: OMNI Networks Commercial |
$147.70
|
| Rate for Payer: One Health Plan PPO/POS |
$189.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$200.45
|
| Rate for Payer: Three Rivers Provider Network All |
$158.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$196.23
|
| Rate for Payer: Zelis Auto |
$84.40
|
|
|
IMPLT SCREW CANCELLOUS SPHERICAL 6.5
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.40 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.80
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
|
|
IMPLT SCREW CANCELLOUS SPHERICAL 6.5
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$300.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Humana ChoiceCare |
$97.76
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$225.60
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$330.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$188.00
|
|
|
IMPLT SCREW CANCELLOUS SS 4.0
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
|
|
IMPLT SCREW CANCELLOUS SS 4.0
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
|
IMPLT SCREW CANCELLOUS THREADED 4.0MM
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.25 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$262.65
|
| Rate for Payer: First Health Commercial |
$278.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$278.10
|
| Rate for Payer: GEHA Commercial |
$247.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$278.10
|
| Rate for Payer: Humana ChoiceCare |
$80.34
|
| Rate for Payer: Multiplan All |
$281.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$185.40
|
| Rate for Payer: OMNI Networks Commercial |
$216.30
|
| Rate for Payer: One Health Plan PPO/POS |
$278.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$293.55
|
| Rate for Payer: Three Rivers Provider Network All |
$231.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$271.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$77.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$287.37
|
| Rate for Payer: Zelis Auto |
$123.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$154.50
|
|
|
IMPLT SCREW CANCELLOUS THREADED 4.0MM
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$247.20
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$262.65
|
| Rate for Payer: First Health Commercial |
$278.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$278.10
|
| Rate for Payer: GEHA Commercial |
$216.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$278.10
|
| Rate for Payer: Multiplan All |
$281.19
|
| Rate for Payer: OMNI Networks Commercial |
$216.30
|
| Rate for Payer: One Health Plan PPO/POS |
$278.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$293.55
|
| Rate for Payer: Three Rivers Provider Network All |
$231.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$287.37
|
| Rate for Payer: Zelis Auto |
$123.60
|
|
|
IMPLT SCREW CANCELLOUS THREADED 6X60MM
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.40
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$261.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
|
|
IMPLT SCREW CANCELLOUS THREADED 6X60MM
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$298.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Humana ChoiceCare |
$96.98
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$223.80
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$328.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$93.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$186.50
|
|
|
IMPLT SCREW CANCELLOUS THREADED 6X65MM
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003120
|
|
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 CANCELLOUS THREADED 6X65MM
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.40
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$261.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
|
|
IMPLT SCREW CANCELLOUS THREADED 6X65MM
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003120
|
|
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 CANCELLOUS THREADED 6X65MM
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$298.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Humana ChoiceCare |
$96.98
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$223.80
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$328.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$93.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$186.50
|
|
|
IMPLT SCREW CANCELLOUS THREADED 6X70MM
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.25 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$378.25
|
| Rate for Payer: First Health Commercial |
$400.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$400.50
|
| Rate for Payer: GEHA Commercial |
$356.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$400.50
|
| Rate for Payer: Humana ChoiceCare |
$115.70
|
| Rate for Payer: Multiplan All |
$404.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$267.00
|
| Rate for Payer: OMNI Networks Commercial |
$311.50
|
| Rate for Payer: One Health Plan PPO/POS |
$400.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$422.75
|
| Rate for Payer: Three Rivers Provider Network All |
$333.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$391.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$413.85
|
| Rate for Payer: Zelis Auto |
$178.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$222.50
|
|
|
IMPLT SCREW CANCELLOUS THREADED 6X70MM
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$298.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Humana ChoiceCare |
$96.98
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$223.80
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$328.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$93.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$186.50
|
|
|
IMPLT SCREW CANCELLOUS THREADED 6X70MM
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.40
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$261.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
|
|
IMPLT SCREW CANCELLOUS THREADED 6X70MM
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$356.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$378.25
|
| Rate for Payer: First Health Commercial |
$400.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$400.50
|
| Rate for Payer: GEHA Commercial |
$311.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$400.50
|
| Rate for Payer: Multiplan All |
$404.95
|
| Rate for Payer: OMNI Networks Commercial |
$311.50
|
| Rate for Payer: One Health Plan PPO/POS |
$400.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$422.75
|
| Rate for Payer: Three Rivers Provider Network All |
$333.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$413.85
|
| Rate for Payer: Zelis Auto |
$178.00
|
|
|
IMPLT SCREW CANCELLOUS THREADED 6X75MM
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003121
|
|
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 CANCELLOUS THREADED 6X75MM
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003121
|
|
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 CANCELLOUS THREADED 6X75MM
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$298.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Humana ChoiceCare |
$96.98
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$223.80
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$328.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$93.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$186.50
|
|
|
IMPLT SCREW CANCELLOUS THREADED 6X75MM
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.40
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$317.05
|
| Rate for Payer: First Health Commercial |
$335.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$335.70
|
| Rate for Payer: GEHA Commercial |
$261.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$335.70
|
| Rate for Payer: Multiplan All |
$339.43
|
| Rate for Payer: OMNI Networks Commercial |
$261.10
|
| Rate for Payer: One Health Plan PPO/POS |
$335.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$354.35
|
| Rate for Payer: Three Rivers Provider Network All |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$346.89
|
| Rate for Payer: Zelis Auto |
$149.20
|
|
|
IMPLT SCREW CANCELLOUS TORX 6.5X30MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.60
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
|
