|
IMPLT SCREW LOCKING 3.5X14MM
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$704.80
|
| 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 |
$616.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Multiplan All |
$801.71
|
| 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: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
|
|
IMPLT SCREW LOCKING 3.5X14MM
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$271.20
|
| 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 |
$361.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Humana ChoiceCare |
$117.52
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$271.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$397.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$113.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.00
|
|
|
IMPLT SCREW LOCKING 3.5X14MM
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000573
|
|
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 3.5X16
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000574
|
|
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 3.5X16
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000574
|
|
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 3.5X16MM
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006111
|
|
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 3.5X16MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$664.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$594.15
|
| Rate for Payer: First Health Commercial |
$629.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$629.10
|
| Rate for Payer: GEHA Commercial |
$559.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$629.10
|
| Rate for Payer: Humana ChoiceCare |
$181.74
|
| Rate for Payer: Multiplan All |
$636.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$419.40
|
| Rate for Payer: OMNI Networks Commercial |
$489.30
|
| Rate for Payer: One Health Plan PPO/POS |
$629.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$664.05
|
| Rate for Payer: Three Rivers Provider Network All |
$524.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$615.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$174.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$650.07
|
| Rate for Payer: Zelis Auto |
$279.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$349.50
|
|
|
IMPLT SCREW LOCKING 3.5X16MM
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006111
|
|
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 3.5X16MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$664.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$559.20
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$594.15
|
| Rate for Payer: First Health Commercial |
$629.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$629.10
|
| Rate for Payer: GEHA Commercial |
$489.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$629.10
|
| Rate for Payer: Multiplan All |
$636.09
|
| Rate for Payer: OMNI Networks Commercial |
$489.30
|
| Rate for Payer: One Health Plan PPO/POS |
$629.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$664.05
|
| Rate for Payer: Three Rivers Provider Network All |
$524.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$650.07
|
| Rate for Payer: Zelis Auto |
$279.60
|
|
|
IMPLT SCREW LOCKING 3.5X16MM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$560.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$595.00
|
| Rate for Payer: First Health Commercial |
$630.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.00
|
| Rate for Payer: GEHA Commercial |
$490.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.00
|
| Rate for Payer: Multiplan All |
$637.00
|
| Rate for Payer: OMNI Networks Commercial |
$490.00
|
| Rate for Payer: One Health Plan PPO/POS |
$630.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.00
|
| Rate for Payer: Three Rivers Provider Network All |
$525.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.00
|
| Rate for Payer: Zelis Auto |
$280.00
|
|
|
IMPLT SCREW LOCKING 3.5X16MM
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000950
|
|
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 3.5X16MM
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000920
|
|
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 3.5X16MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000919
|
|
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 3.5X16MM
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$704.80
|
| 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 |
$616.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Multiplan All |
$801.71
|
| 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: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
|
|
IMPLT SCREW LOCKING 3.5X16MM
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000920
|
|
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 3.5X16MM
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000576
|
|
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 3.5X16MM
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000576
|
|
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 3.5X18
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.40 |
| Max. Negotiated Rate |
$946.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$796.80
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$697.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$926.28
|
| Rate for Payer: Zelis Auto |
$398.40
|
|
|
IMPLT SCREW LOCKING 3.5X18
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.00 |
| Max. Negotiated Rate |
$946.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$796.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Humana ChoiceCare |
$258.96
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$597.60
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$876.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$926.28
|
| Rate for Payer: Zelis Auto |
$398.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.00
|
|
|
IMPLT SCREW LOCKING 3.5X18MM
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$785.40
|
| Rate for Payer: First Health Commercial |
$831.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$831.60
|
| Rate for Payer: GEHA Commercial |
$739.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$831.60
|
| Rate for Payer: Humana ChoiceCare |
$240.24
|
| Rate for Payer: Multiplan All |
$840.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$554.40
|
| Rate for Payer: OMNI Networks Commercial |
$646.80
|
| Rate for Payer: One Health Plan PPO/POS |
$831.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$877.80
|
| Rate for Payer: Three Rivers Provider Network All |
$693.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$813.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$231.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$859.32
|
| Rate for Payer: Zelis Auto |
$369.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$462.00
|
|
|
IMPLT SCREW LOCKING 3.5X18MM
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000921
|
|
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 3.5X18MM
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000921
|
|
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 3.5X18MM
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$739.20
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$785.40
|
| Rate for Payer: First Health Commercial |
$831.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$831.60
|
| Rate for Payer: GEHA Commercial |
$646.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$831.60
|
| Rate for Payer: Multiplan All |
$840.84
|
| Rate for Payer: OMNI Networks Commercial |
$646.80
|
| Rate for Payer: One Health Plan PPO/POS |
$831.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$877.80
|
| Rate for Payer: Three Rivers Provider Network All |
$693.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$859.32
|
| Rate for Payer: Zelis Auto |
$369.60
|
|
|
IMPLT SCREW LOCKING 3.5X18MM
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006110
|
|
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 3.5X18MM
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006110
|
|
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
|
|
