|
IMPLT SCREW LOCKING 05X75MM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW LOCKING 05X75MM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW LOCKING 10X3.5MM
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.80 |
| Max. Negotiated Rate |
$723.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$609.60
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$647.70
|
| Rate for Payer: First Health Commercial |
$685.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$685.80
|
| Rate for Payer: GEHA Commercial |
$533.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$685.80
|
| Rate for Payer: Multiplan All |
$693.42
|
| Rate for Payer: OMNI Networks Commercial |
$533.40
|
| Rate for Payer: One Health Plan PPO/POS |
$685.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$723.90
|
| Rate for Payer: Three Rivers Provider Network All |
$571.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$708.66
|
| Rate for Payer: Zelis Auto |
$304.80
|
|
|
IMPLT SCREW LOCKING 10X3.5MM
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.50 |
| Max. Negotiated Rate |
$723.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$647.70
|
| Rate for Payer: First Health Commercial |
$685.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$685.80
|
| Rate for Payer: GEHA Commercial |
$609.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$685.80
|
| Rate for Payer: Humana ChoiceCare |
$198.12
|
| Rate for Payer: Multiplan All |
$693.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$457.20
|
| Rate for Payer: OMNI Networks Commercial |
$533.40
|
| Rate for Payer: One Health Plan PPO/POS |
$685.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$723.90
|
| Rate for Payer: Three Rivers Provider Network All |
$571.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$670.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$708.66
|
| Rate for Payer: Zelis Auto |
$304.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$381.00
|
|
|
IMPLT SCREW LOCKING 12MM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.50 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$433.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Humana ChoiceCare |
$140.92
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$325.20
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$476.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$271.00
|
|
|
IMPLT SCREW LOCKING 12MM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.80 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$433.60
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$379.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
|
|
IMPLT SCREW LOCKING 12X3.5MM
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.50 |
| Max. Negotiated Rate |
$723.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$647.70
|
| Rate for Payer: First Health Commercial |
$685.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$685.80
|
| Rate for Payer: GEHA Commercial |
$609.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$685.80
|
| Rate for Payer: Humana ChoiceCare |
$198.12
|
| Rate for Payer: Multiplan All |
$693.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$457.20
|
| Rate for Payer: OMNI Networks Commercial |
$533.40
|
| Rate for Payer: One Health Plan PPO/POS |
$685.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$723.90
|
| Rate for Payer: Three Rivers Provider Network All |
$571.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$670.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$708.66
|
| Rate for Payer: Zelis Auto |
$304.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$381.00
|
|
|
IMPLT SCREW LOCKING 12X3.5MM
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.80 |
| Max. Negotiated Rate |
$723.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$609.60
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$647.70
|
| Rate for Payer: First Health Commercial |
$685.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$685.80
|
| Rate for Payer: GEHA Commercial |
$533.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$685.80
|
| Rate for Payer: Multiplan All |
$693.42
|
| Rate for Payer: OMNI Networks Commercial |
$533.40
|
| Rate for Payer: One Health Plan PPO/POS |
$685.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$723.90
|
| Rate for Payer: Three Rivers Provider Network All |
$571.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$708.66
|
| Rate for Payer: Zelis Auto |
$304.80
|
|
|
IMPLT SCREW LOCKING 12X3MM
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001487
|
|
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 LOCKING 12X3MM
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001487
|
|
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 LOCKING 15MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW LOCKING 15MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW LOCKING 1.7X10MM
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$432.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$378.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
|
|
IMPLT SCREW LOCKING 1.7X10MM
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$432.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Humana ChoiceCare |
$140.40
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.00
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$475.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$270.00
|
|
|
IMPLT SCREW LOCKING 1.7X11MM
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$432.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Humana ChoiceCare |
$140.40
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.00
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$475.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$270.00
|
|
|
IMPLT SCREW LOCKING 1.7X11MM
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$432.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$378.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
|
|
IMPLT SCREW LOCKING 1.7X12MM
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$432.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$378.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
|
|
IMPLT SCREW LOCKING 1.7X12MM
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$432.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Humana ChoiceCare |
$140.40
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.00
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$475.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$270.00
|
|
|
IMPLT SCREW LOCKING 1.7X13MM
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$432.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$378.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
|
|
IMPLT SCREW LOCKING 1.7X13MM
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$432.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Humana ChoiceCare |
$140.40
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.00
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$475.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$270.00
|
|
|
IMPLT SCREW, LOCKING 1.7X14MM
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$432.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Humana ChoiceCare |
$140.40
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.00
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$475.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$270.00
|
|
|
IMPLT SCREW, LOCKING 1.7X14MM
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$432.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$378.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
|
|
IMPLT SCREW, LOCKING 1.7X16MM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$560.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$595.00
|
| Rate for Payer: First Health Commercial |
$630.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.00
|
| Rate for Payer: GEHA Commercial |
$490.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.00
|
| Rate for Payer: Multiplan All |
$637.00
|
| Rate for Payer: OMNI Networks Commercial |
$490.00
|
| Rate for Payer: One Health Plan PPO/POS |
$630.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.00
|
| Rate for Payer: Three Rivers Provider Network All |
$525.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.00
|
| Rate for Payer: Zelis Auto |
$280.00
|
|
|
IMPLT SCREW, LOCKING 1.7X16MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$595.00
|
| Rate for Payer: First Health Commercial |
$630.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.00
|
| Rate for Payer: GEHA Commercial |
$560.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.00
|
| Rate for Payer: Humana ChoiceCare |
$182.00
|
| Rate for Payer: Multiplan All |
$637.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$420.00
|
| Rate for Payer: OMNI Networks Commercial |
$490.00
|
| Rate for Payer: One Health Plan PPO/POS |
$630.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.00
|
| Rate for Payer: Three Rivers Provider Network All |
$525.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$616.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$175.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.00
|
| Rate for Payer: Zelis Auto |
$280.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$350.00
|
|
|
IMPLT SCREW, LOCKING 1.7X18MM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$560.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$595.00
|
| Rate for Payer: First Health Commercial |
$630.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.00
|
| Rate for Payer: GEHA Commercial |
$490.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.00
|
| Rate for Payer: Multiplan All |
$637.00
|
| Rate for Payer: OMNI Networks Commercial |
$490.00
|
| Rate for Payer: One Health Plan PPO/POS |
$630.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.00
|
| Rate for Payer: Three Rivers Provider Network All |
$525.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.00
|
| Rate for Payer: Zelis Auto |
$280.00
|
|
