|
IMPLT SCREW, LOCKING 1.7X18MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006757
|
|
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 1.7X6MM
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000956
|
|
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 1.7X6MM
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000956
|
|
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 20MM
|
Facility
|
OP
|
$1,289.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.25 |
| Max. Negotiated Rate |
$1,224.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,095.65
|
| Rate for Payer: First Health Commercial |
$1,160.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.10
|
| Rate for Payer: GEHA Commercial |
$1,031.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.10
|
| Rate for Payer: Humana ChoiceCare |
$335.14
|
| Rate for Payer: Multiplan All |
$1,172.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$773.40
|
| Rate for Payer: OMNI Networks Commercial |
$902.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.55
|
| Rate for Payer: Three Rivers Provider Network All |
$966.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,134.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$322.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.77
|
| Rate for Payer: Zelis Auto |
$515.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$644.50
|
|
|
IMPLT SCREW LOCKING 20MM
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.60 |
| Max. Negotiated Rate |
$1,224.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,031.20
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,095.65
|
| Rate for Payer: First Health Commercial |
$1,160.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.10
|
| Rate for Payer: GEHA Commercial |
$902.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.10
|
| Rate for Payer: Multiplan All |
$1,172.99
|
| Rate for Payer: OMNI Networks Commercial |
$902.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.55
|
| Rate for Payer: Three Rivers Provider Network All |
$966.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.77
|
| Rate for Payer: Zelis Auto |
$515.60
|
|
|
IMPLT SCREW LOCKING 2.3MM
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$548.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Humana ChoiceCare |
$178.10
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$411.00
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$602.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$342.50
|
|
|
IMPLT SCREW LOCKING 2.3MM
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$479.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
|
|
IMPLT SCREW LOCKING 2.3X10MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.60
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$442.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
|
|
IMPLT SCREW LOCKING 2.3X10MM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000559
|
|
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 2.3X10MM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000559
|
|
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 2.3X10MM
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Humana ChoiceCare |
$164.32
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$379.20
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$556.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$158.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$316.00
|
|
|
IMPLT SCREW LOCKING 2.3X11MM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000560
|
|
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 2.3X11MM
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$479.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
|
|
IMPLT SCREW LOCKING 2.3X11MM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000560
|
|
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 2.3X11MM
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$548.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Humana ChoiceCare |
$178.10
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$411.00
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$602.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$342.50
|
|
|
IMPLT SCREW LOCKING 2.3X12MM
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$724.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$457.80
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cigna Commercial |
$648.55
|
| Rate for Payer: First Health Commercial |
$686.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$686.70
|
| Rate for Payer: GEHA Commercial |
$610.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$686.70
|
| Rate for Payer: Humana ChoiceCare |
$198.38
|
| Rate for Payer: Multiplan All |
$694.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$457.80
|
| Rate for Payer: OMNI Networks Commercial |
$534.10
|
| Rate for Payer: One Health Plan PPO/POS |
$686.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$724.85
|
| Rate for Payer: Three Rivers Provider Network All |
$572.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$671.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$190.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$709.59
|
| Rate for Payer: Zelis Auto |
$305.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$381.50
|
|
|
IMPLT SCREW LOCKING 2.3X12MM
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.20 |
| Max. Negotiated Rate |
$724.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$610.40
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cigna Commercial |
$648.55
|
| Rate for Payer: First Health Commercial |
$686.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$686.70
|
| Rate for Payer: GEHA Commercial |
$534.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$686.70
|
| Rate for Payer: Multiplan All |
$694.33
|
| Rate for Payer: OMNI Networks Commercial |
$534.10
|
| Rate for Payer: One Health Plan PPO/POS |
$686.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$724.85
|
| Rate for Payer: Three Rivers Provider Network All |
$572.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$709.59
|
| Rate for Payer: Zelis Auto |
$305.20
|
|
|
IMPLT SCREW LOCKING 2.3X13MM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000562
|
|
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 2.3X13MM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000562
|
|
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 2.3X14MM
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$724.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$457.80
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cigna Commercial |
$648.55
|
| Rate for Payer: First Health Commercial |
$686.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$686.70
|
| Rate for Payer: GEHA Commercial |
$610.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$686.70
|
| Rate for Payer: Humana ChoiceCare |
$198.38
|
| Rate for Payer: Multiplan All |
$694.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$457.80
|
| Rate for Payer: OMNI Networks Commercial |
$534.10
|
| Rate for Payer: One Health Plan PPO/POS |
$686.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$724.85
|
| Rate for Payer: Three Rivers Provider Network All |
$572.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$671.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$190.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$709.59
|
| Rate for Payer: Zelis Auto |
$305.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$381.50
|
|
|
IMPLT SCREW LOCKING 2.3X14MM
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.20 |
| Max. Negotiated Rate |
$724.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$610.40
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cigna Commercial |
$648.55
|
| Rate for Payer: First Health Commercial |
$686.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$686.70
|
| Rate for Payer: GEHA Commercial |
$534.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$686.70
|
| Rate for Payer: Multiplan All |
$694.33
|
| Rate for Payer: OMNI Networks Commercial |
$534.10
|
| Rate for Payer: One Health Plan PPO/POS |
$686.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$724.85
|
| Rate for Payer: Three Rivers Provider Network All |
$572.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$709.59
|
| Rate for Payer: Zelis Auto |
$305.20
|
|
|
IMPLT SCREW LOCKING 2.3X14MM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000563
|
|
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 2.3X14MM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000563
|
|
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 2.3X15MM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002881
|
|
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 2.3X15MM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002881
|
|
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
|
|
