|
IMPLT SCREW CENTRAL 6.5X30MM
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.00 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$820.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$717.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: Zelis Auto |
$410.00
|
|
|
IMPLT SCREW CENTRAL 6.5X30MM
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.25 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$820.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Humana ChoiceCare |
$266.50
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$615.00
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$902.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$256.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: Zelis Auto |
$410.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$512.50
|
|
|
IMPLT SCREW CENTRAL 6.5X35MM
|
Facility
|
OP
|
$1,078.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$1,024.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$916.30
|
| Rate for Payer: First Health Commercial |
$970.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$970.20
|
| Rate for Payer: GEHA Commercial |
$862.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$970.20
|
| Rate for Payer: Humana ChoiceCare |
$280.28
|
| Rate for Payer: Multiplan All |
$980.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$646.80
|
| Rate for Payer: OMNI Networks Commercial |
$754.60
|
| Rate for Payer: One Health Plan PPO/POS |
$970.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,024.10
|
| Rate for Payer: Three Rivers Provider Network All |
$808.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$948.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$269.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,002.54
|
| Rate for Payer: Zelis Auto |
$431.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$539.00
|
|
|
IMPLT SCREW CENTRAL 6.5X35MM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$171.60
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$396.00
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$580.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$330.00
|
|
|
IMPLT SCREW CENTRAL 6.5X35MM
|
Facility
|
IP
|
$1,078.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.20 |
| Max. Negotiated Rate |
$1,024.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$862.40
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$916.30
|
| Rate for Payer: First Health Commercial |
$970.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$970.20
|
| Rate for Payer: GEHA Commercial |
$754.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$970.20
|
| Rate for Payer: Multiplan All |
$980.98
|
| Rate for Payer: OMNI Networks Commercial |
$754.60
|
| Rate for Payer: One Health Plan PPO/POS |
$970.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,024.10
|
| Rate for Payer: Three Rivers Provider Network All |
$808.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,002.54
|
| Rate for Payer: Zelis Auto |
$431.20
|
|
|
IMPLT SCREW CENTRAL 6.5X35MM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
|
|
IMPLT SCREW CENTRAL 6.5X40MM
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.00 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$820.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$717.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: Zelis Auto |
$410.00
|
|
|
IMPLT SCREW CENTRAL 6.5X40MM
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.25 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$820.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Humana ChoiceCare |
$266.50
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$615.00
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$902.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$256.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: Zelis Auto |
$410.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$512.50
|
|
|
IMPLT SCREW CENTRAL 6.5X45MM
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.00 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$820.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$717.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: Zelis Auto |
$410.00
|
|
|
IMPLT SCREW CENTRAL 6.5X45MM
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.25 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$820.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Humana ChoiceCare |
$266.50
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$615.00
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$902.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$256.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: Zelis Auto |
$410.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$512.50
|
|
|
IMPLT SCREW CENTRALIZED 6.5X20MM
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.80 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$849.60
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna Commercial |
$902.70
|
| Rate for Payer: First Health Commercial |
$955.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$955.80
|
| Rate for Payer: GEHA Commercial |
$743.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$955.80
|
| Rate for Payer: Multiplan All |
$966.42
|
| Rate for Payer: OMNI Networks Commercial |
$743.40
|
| Rate for Payer: One Health Plan PPO/POS |
$955.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,008.90
|
| Rate for Payer: Three Rivers Provider Network All |
$796.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$987.66
|
| Rate for Payer: Zelis Auto |
$424.80
|
|
|
IMPLT SCREW CENTRALIZED 6.5X20MM
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna Commercial |
$902.70
|
| Rate for Payer: First Health Commercial |
$955.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$955.80
|
| Rate for Payer: GEHA Commercial |
$849.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$955.80
|
| Rate for Payer: Humana ChoiceCare |
$276.12
|
| Rate for Payer: Multiplan All |
$966.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$637.20
|
| Rate for Payer: OMNI Networks Commercial |
$743.40
|
| Rate for Payer: One Health Plan PPO/POS |
$955.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,008.90
|
| Rate for Payer: Three Rivers Provider Network All |
$796.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$934.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$265.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$987.66
|
| Rate for Payer: Zelis Auto |
$424.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$531.00
|
|
|
IMPLT SCREW COMPRESSION 2.0MM
|
Facility
|
IP
|
$1,995.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.00 |
| Max. Negotiated Rate |
$1,895.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,596.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna Commercial |
$1,695.75
|
| Rate for Payer: First Health Commercial |
$1,795.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,795.50
|
| Rate for Payer: GEHA Commercial |
$1,396.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,795.50
|
| Rate for Payer: Multiplan All |
$1,815.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,396.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,795.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,895.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,496.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,855.35
|
| Rate for Payer: Zelis Auto |
$798.00
|
|
|
IMPLT SCREW COMPRESSION 2.0MM
|
Facility
|
OP
|
$1,995.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$498.75 |
| Max. Negotiated Rate |
$1,895.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,197.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna Commercial |
$1,695.75
|
| Rate for Payer: First Health Commercial |
$1,795.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,795.50
|
| Rate for Payer: GEHA Commercial |
$1,596.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,795.50
|
| Rate for Payer: Humana ChoiceCare |
$518.70
|
| Rate for Payer: Multiplan All |
$1,815.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,197.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,396.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,795.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,895.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,496.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,755.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$498.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,855.35
|
| Rate for Payer: Zelis Auto |
$798.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$997.50
|
|
|
IMPLT SCREW COMPRESSION 2.0X12MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW COMPRESSION 2.0X12MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW COMPRESSION 2.0X14MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW COMPRESSION 2.0X14MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW COMPRESSION 2.0X15MM
|
Facility
|
OP
|
$1,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.75 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$978.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Humana ChoiceCare |
$317.98
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$733.80
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,076.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$305.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$611.50
|
|
|
IMPLT SCREW COMPRESSION 2.0X15MM
|
Facility
|
IP
|
$1,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.20 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$978.40
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$856.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
|
|
IMPLT SCREW COMPRESSION 2.0X16MM
|
Facility
|
IP
|
$1,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.20 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$978.40
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$856.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
|
|
IMPLT SCREW COMPRESSION 2.0X16MM
|
Facility
|
OP
|
$1,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.75 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$978.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Humana ChoiceCare |
$317.98
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$733.80
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,076.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$305.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$611.50
|
|
|
IMPLT SCREW COMPRESSION 2.5X12MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW COMPRESSION 2.5X12MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW COMPRESSION 2.5X13MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
