|
IMPLT SCREW LOCKING 3.5X10MM
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.80 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$637.60
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$557.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: Zelis Auto |
$318.80
|
|
|
IMPLT SCREW LOCKING 3.5X10MM
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$704.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Humana ChoiceCare |
$229.06
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$528.60
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$775.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$440.50
|
|
|
IMPLT SCREW LOCKING 3.5X10MM
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.50 |
| Max. Negotiated Rate |
$708.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$634.10
|
| Rate for Payer: First Health Commercial |
$671.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$671.40
|
| Rate for Payer: GEHA Commercial |
$596.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$671.40
|
| Rate for Payer: Humana ChoiceCare |
$193.96
|
| Rate for Payer: Multiplan All |
$678.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$447.60
|
| Rate for Payer: OMNI Networks Commercial |
$522.20
|
| Rate for Payer: One Health Plan PPO/POS |
$671.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$708.70
|
| Rate for Payer: Three Rivers Provider Network All |
$559.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$656.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$186.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$693.78
|
| Rate for Payer: Zelis Auto |
$298.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$373.00
|
|
|
IMPLT SCREW LOCKING 3.5X10MM
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.40 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$608.80
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$532.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
|
|
IMPLT SCREW LOCKING 3.5X10MM
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.40 |
| Max. Negotiated Rate |
$708.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$596.80
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$634.10
|
| Rate for Payer: First Health Commercial |
$671.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$671.40
|
| Rate for Payer: GEHA Commercial |
$522.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$671.40
|
| Rate for Payer: Multiplan All |
$678.86
|
| Rate for Payer: OMNI Networks Commercial |
$522.20
|
| Rate for Payer: One Health Plan PPO/POS |
$671.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$708.70
|
| Rate for Payer: Three Rivers Provider Network All |
$559.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$693.78
|
| Rate for Payer: Zelis Auto |
$298.40
|
|
|
IMPLT SCREW LOCKING 3.5X10MM
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.80 |
| Max. Negotiated Rate |
$842.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$709.60
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$753.95
|
| Rate for Payer: First Health Commercial |
$798.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.30
|
| Rate for Payer: GEHA Commercial |
$620.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.30
|
| Rate for Payer: Multiplan All |
$807.17
|
| Rate for Payer: OMNI Networks Commercial |
$620.90
|
| Rate for Payer: One Health Plan PPO/POS |
$798.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.65
|
| Rate for Payer: Three Rivers Provider Network All |
$665.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$824.91
|
| Rate for Payer: Zelis Auto |
$354.80
|
|
|
IMPLT SCREW LOCKING 3.5X12MM
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.50 |
| Max. Negotiated Rate |
$708.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$634.10
|
| Rate for Payer: First Health Commercial |
$671.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$671.40
|
| Rate for Payer: GEHA Commercial |
$596.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$671.40
|
| Rate for Payer: Humana ChoiceCare |
$193.96
|
| Rate for Payer: Multiplan All |
$678.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$447.60
|
| Rate for Payer: OMNI Networks Commercial |
$522.20
|
| Rate for Payer: One Health Plan PPO/POS |
$671.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$708.70
|
| Rate for Payer: Three Rivers Provider Network All |
$559.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$656.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$186.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$693.78
|
| Rate for Payer: Zelis Auto |
$298.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$373.00
|
|
|
IMPLT SCREW LOCKING 3.5X12MM
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.20 |
| Max. Negotiated Rate |
$1,228.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,034.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$1,099.05
|
| Rate for Payer: First Health Commercial |
$1,163.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,163.70
|
| Rate for Payer: GEHA Commercial |
$905.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,163.70
|
| Rate for Payer: Multiplan All |
$1,176.63
|
| Rate for Payer: OMNI Networks Commercial |
$905.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,163.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,228.35
|
| Rate for Payer: Three Rivers Provider Network All |
$969.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,202.49
|
| Rate for Payer: Zelis Auto |
$517.20
|
|
|
IMPLT SCREW LOCKING 3.5X12MM
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.40 |
| Max. Negotiated Rate |
$708.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$596.80
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$634.10
|
| Rate for Payer: First Health Commercial |
$671.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$671.40
|
| Rate for Payer: GEHA Commercial |
$522.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$671.40
|
| Rate for Payer: Multiplan All |
$678.86
|
| Rate for Payer: OMNI Networks Commercial |
$522.20
|
| Rate for Payer: One Health Plan PPO/POS |
$671.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$708.70
|
| Rate for Payer: Three Rivers Provider Network All |
$559.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$693.78
|
| Rate for Payer: Zelis Auto |
$298.40
|
|
|
IMPLT SCREW LOCKING 3.5X12MM
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$532.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$465.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| Rate for Payer: Multiplan All |
$605.15
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$631.75
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$618.45
|
| Rate for Payer: Zelis Auto |
$266.00
|
|
|
IMPLT SCREW LOCKING 3.5X12MM
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$323.25 |
| Max. Negotiated Rate |
$1,228.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$1,099.05
|
| Rate for Payer: First Health Commercial |
$1,163.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,163.70
|
| Rate for Payer: GEHA Commercial |
$1,034.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,163.70
|
| Rate for Payer: Humana ChoiceCare |
$336.18
|
| Rate for Payer: Multiplan All |
$1,176.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$775.80
|
| Rate for Payer: OMNI Networks Commercial |
$905.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,163.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,228.35
|
| Rate for Payer: Three Rivers Provider Network All |
$969.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,137.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,202.49
|
| Rate for Payer: Zelis Auto |
$517.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$646.50
|
|
|
IMPLT SCREW LOCKING 3.5X12MM
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.80 |
| Max. Negotiated Rate |
$842.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$709.60
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$753.95
|
| Rate for Payer: First Health Commercial |
$798.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.30
|
| Rate for Payer: GEHA Commercial |
$620.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.30
|
| Rate for Payer: Multiplan All |
$807.17
|
| Rate for Payer: OMNI Networks Commercial |
$620.90
|
| Rate for Payer: One Health Plan PPO/POS |
$798.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.65
|
| Rate for Payer: Three Rivers Provider Network All |
$665.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$824.91
|
| Rate for Payer: Zelis Auto |
$354.80
|
|
|
IMPLT SCREW LOCKING 3.5X12MM
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.75 |
| Max. Negotiated Rate |
$842.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$753.95
|
| Rate for Payer: First Health Commercial |
$798.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.30
|
| Rate for Payer: GEHA Commercial |
$709.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.30
|
| Rate for Payer: Humana ChoiceCare |
$230.62
|
| Rate for Payer: Multiplan All |
$807.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$532.20
|
| Rate for Payer: OMNI Networks Commercial |
$620.90
|
| Rate for Payer: One Health Plan PPO/POS |
$798.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.65
|
| Rate for Payer: Three Rivers Provider Network All |
$665.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$780.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$221.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$824.91
|
| Rate for Payer: Zelis Auto |
$354.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$443.50
|
|
|
IMPLT SCREW LOCKING 3.5X12MM
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.25 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$532.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| Rate for Payer: Humana ChoiceCare |
$172.90
|
| Rate for Payer: Multiplan All |
$605.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$399.00
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$631.75
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$585.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$166.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$618.45
|
| Rate for Payer: Zelis Auto |
$266.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$332.50
|
|
|
IMPLT SCREW LOCKING 3.5X14MM
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.80 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$637.60
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$557.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: Zelis Auto |
$318.80
|
|
|
IMPLT SCREW LOCKING 3.5X14MM
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000918
|
|
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 3.5X14MM
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$704.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Humana ChoiceCare |
$229.06
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$528.60
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$775.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$440.50
|
|
|
IMPLT SCREW LOCKING 3.5X14MM
|
Facility
|
OP
|
$1,378.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.50 |
| Max. Negotiated Rate |
$1,309.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$1,171.30
|
| Rate for Payer: First Health Commercial |
$1,240.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,240.20
|
| Rate for Payer: GEHA Commercial |
$1,102.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,240.20
|
| Rate for Payer: Humana ChoiceCare |
$358.28
|
| Rate for Payer: Multiplan All |
$1,253.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$826.80
|
| Rate for Payer: OMNI Networks Commercial |
$964.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,240.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,309.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,033.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,212.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$344.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,281.54
|
| Rate for Payer: Zelis Auto |
$551.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$689.00
|
|
|
IMPLT SCREW LOCKING 3.5X14MM
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.40 |
| Max. Negotiated Rate |
$708.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$596.80
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$634.10
|
| Rate for Payer: First Health Commercial |
$671.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$671.40
|
| Rate for Payer: GEHA Commercial |
$522.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$671.40
|
| Rate for Payer: Multiplan All |
$678.86
|
| Rate for Payer: OMNI Networks Commercial |
$522.20
|
| Rate for Payer: One Health Plan PPO/POS |
$671.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$708.70
|
| Rate for Payer: Three Rivers Provider Network All |
$559.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$693.78
|
| Rate for Payer: Zelis Auto |
$298.40
|
|
|
IMPLT SCREW LOCKING 3.5X14MM
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.80 |
| Max. Negotiated Rate |
$842.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$709.60
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$753.95
|
| Rate for Payer: First Health Commercial |
$798.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.30
|
| Rate for Payer: GEHA Commercial |
$620.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.30
|
| Rate for Payer: Multiplan All |
$807.17
|
| Rate for Payer: OMNI Networks Commercial |
$620.90
|
| Rate for Payer: One Health Plan PPO/POS |
$798.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.65
|
| Rate for Payer: Three Rivers Provider Network All |
$665.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$824.91
|
| Rate for Payer: Zelis Auto |
$354.80
|
|
|
IMPLT SCREW LOCKING 3.5X14MM
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.75 |
| Max. Negotiated Rate |
$842.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$753.95
|
| Rate for Payer: First Health Commercial |
$798.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.30
|
| Rate for Payer: GEHA Commercial |
$709.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.30
|
| Rate for Payer: Humana ChoiceCare |
$230.62
|
| Rate for Payer: Multiplan All |
$807.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$532.20
|
| Rate for Payer: OMNI Networks Commercial |
$620.90
|
| Rate for Payer: One Health Plan PPO/POS |
$798.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.65
|
| Rate for Payer: Three Rivers Provider Network All |
$665.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$780.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$221.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$824.91
|
| Rate for Payer: Zelis Auto |
$354.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$443.50
|
|
|
IMPLT SCREW LOCKING 3.5X14MM
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.60
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$316.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
|
|
IMPLT SCREW LOCKING 3.5X14MM
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$637.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Humana ChoiceCare |
$207.22
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$478.20
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$701.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$199.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: Zelis Auto |
$318.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$398.50
|
|
|
IMPLT SCREW LOCKING 3.5X14MM
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000918
|
|
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 3.5X14MM
|
Facility
|
IP
|
$1,378.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.20 |
| Max. Negotiated Rate |
$1,309.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,102.40
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$1,171.30
|
| Rate for Payer: First Health Commercial |
$1,240.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,240.20
|
| Rate for Payer: GEHA Commercial |
$964.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,240.20
|
| Rate for Payer: Multiplan All |
$1,253.98
|
| Rate for Payer: OMNI Networks Commercial |
$964.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,240.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,309.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,033.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,281.54
|
| Rate for Payer: Zelis Auto |
$551.20
|
|
