|
IMPLT SCREW LOCKING 2.3X16MM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000564
|
|
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 2.3X16MM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000564
|
|
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 2.3X16MM
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$741.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$624.80
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cigna Commercial |
$663.85
|
| Rate for Payer: First Health Commercial |
$702.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$702.90
|
| Rate for Payer: GEHA Commercial |
$546.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$702.90
|
| Rate for Payer: Multiplan All |
$710.71
|
| Rate for Payer: OMNI Networks Commercial |
$546.70
|
| Rate for Payer: One Health Plan PPO/POS |
$702.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$741.95
|
| Rate for Payer: Three Rivers Provider Network All |
$585.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$726.33
|
| Rate for Payer: Zelis Auto |
$312.40
|
|
|
IMPLT SCREW LOCKING 2.3X16MM
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.25 |
| Max. Negotiated Rate |
$741.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$468.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cigna Commercial |
$663.85
|
| Rate for Payer: First Health Commercial |
$702.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$702.90
|
| Rate for Payer: GEHA Commercial |
$624.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$702.90
|
| Rate for Payer: Humana ChoiceCare |
$203.06
|
| Rate for Payer: Multiplan All |
$710.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$468.60
|
| Rate for Payer: OMNI Networks Commercial |
$546.70
|
| Rate for Payer: One Health Plan PPO/POS |
$702.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$741.95
|
| Rate for Payer: Three Rivers Provider Network All |
$585.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$687.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$726.33
|
| Rate for Payer: Zelis Auto |
$312.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$390.50
|
|
|
IMPLT SCREW LOCKING 2.3X18MM
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.60 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$619.20
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$541.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
|
|
IMPLT SCREW LOCKING 2.3X18MM
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$619.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Humana ChoiceCare |
$201.24
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$464.40
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$681.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$193.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$387.00
|
|
|
IMPLT SCREW LOCKING 2.3X20MM
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000942
|
|
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 2.3X20MM
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000942
|
|
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 2.3X22MM
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001505
|
|
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 2.3X22MM
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001505
|
|
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 2.3X6MM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000565
|
|
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 2.3X6MM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000565
|
|
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 2.3X8MM
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$422.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$369.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
|
|
IMPLT SCREW LOCKING 2.3X8MM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000591
|
|
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 2.3X8MM
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$422.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Humana ChoiceCare |
$137.28
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$316.80
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$464.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$132.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.00
|
|
|
IMPLT SCREW LOCKING 2.3X8MM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000591
|
|
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 2.3X9MM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000566
|
|
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 2.3X9MM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000566
|
|
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 2.7MMCRTX 8MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
|
|
IMPLT SCREW LOCKING 2.7MMCRTX 8MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.40
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
|
|
IMPLT SCREW LOCKING 2.7MMX26MM
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.60 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$843.20
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$737.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| Rate for Payer: Multiplan All |
$959.14
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,001.30
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$980.22
|
| Rate for Payer: Zelis Auto |
$421.60
|
|
|
IMPLT SCREW LOCKING 2.7MMX26MM
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.50 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$843.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| Rate for Payer: Humana ChoiceCare |
$274.04
|
| Rate for Payer: Multiplan All |
$959.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$632.40
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,001.30
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$927.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$980.22
|
| Rate for Payer: Zelis Auto |
$421.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.00
|
|
|
IMPLT SCREW LOCKING 2.7MMX32MM
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.50 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$843.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| Rate for Payer: Humana ChoiceCare |
$274.04
|
| Rate for Payer: Multiplan All |
$959.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$632.40
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,001.30
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$927.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$980.22
|
| Rate for Payer: Zelis Auto |
$421.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.00
|
|
|
IMPLT SCREW LOCKING 2.7MMX32MM
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.60 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$843.20
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$737.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| Rate for Payer: Multiplan All |
$959.14
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,001.30
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$980.22
|
| Rate for Payer: Zelis Auto |
$421.60
|
|
|
IMPLT SCREW LOCKING 2.7X08MM
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.00 |
| Max. Negotiated Rate |
$619.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cigna Commercial |
$554.20
|
| Rate for Payer: First Health Commercial |
$586.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$586.80
|
| Rate for Payer: GEHA Commercial |
$521.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.80
|
| Rate for Payer: Humana ChoiceCare |
$169.52
|
| Rate for Payer: Multiplan All |
$593.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$391.20
|
| Rate for Payer: OMNI Networks Commercial |
$456.40
|
| Rate for Payer: One Health Plan PPO/POS |
$586.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$619.40
|
| Rate for Payer: Three Rivers Provider Network All |
$489.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$573.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$163.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$606.36
|
| Rate for Payer: Zelis Auto |
$260.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$326.00
|
|
