|
IMPLT SCREW LOCKING 3.5X24MM
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.00 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$716.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$626.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
|
|
IMPLT SCREW LOCKING 3.5X26MM
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$561.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Humana ChoiceCare |
$182.52
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$421.20
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$617.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$351.00
|
|
|
IMPLT SCREW LOCKING 3.5X26MM
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.60
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$491.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
|
|
IMPLT SCREW LOCKING 3.5X26MM
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.00 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$716.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$626.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
|
|
IMPLT SCREW LOCKING 3.5X26MM
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.75 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$716.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Humana ChoiceCare |
$232.70
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$537.00
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$787.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$447.50
|
|
|
IMPLT SCREW LOCKING 3.5X28
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000578
|
|
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 3.5X28
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000578
|
|
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 3.5X28MM
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.60
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$491.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
|
|
IMPLT SCREW LOCKING 3.5X28MM
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$561.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Humana ChoiceCare |
$182.52
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$421.20
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$617.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$351.00
|
|
|
IMPLT SCREW LOCKING 3.5X30
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003149
|
|
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 3.5X30
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003149
|
|
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 3.5X30MM
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.00 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$716.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$626.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
|
|
IMPLT SCREW LOCKING 3.5X30MM
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.60
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$491.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
|
|
IMPLT SCREW LOCKING 3.5X30MM
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$561.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Humana ChoiceCare |
$182.52
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$421.20
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$617.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$351.00
|
|
|
IMPLT SCREW LOCKING 3.5X30MM
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$377.60 |
| Max. Negotiated Rate |
$896.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$755.20
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$802.40
|
| Rate for Payer: First Health Commercial |
$849.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$849.60
|
| Rate for Payer: GEHA Commercial |
$660.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$849.60
|
| Rate for Payer: Multiplan All |
$859.04
|
| Rate for Payer: OMNI Networks Commercial |
$660.80
|
| Rate for Payer: One Health Plan PPO/POS |
$849.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$896.80
|
| Rate for Payer: Three Rivers Provider Network All |
$708.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$877.92
|
| Rate for Payer: Zelis Auto |
$377.60
|
|
|
IMPLT SCREW LOCKING 3.5X30MM
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.75 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$716.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Humana ChoiceCare |
$232.70
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$537.00
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$787.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$447.50
|
|
|
IMPLT SCREW LOCKING 3.5X30MM
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.00 |
| Max. Negotiated Rate |
$896.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$566.40
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$802.40
|
| Rate for Payer: First Health Commercial |
$849.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$849.60
|
| Rate for Payer: GEHA Commercial |
$755.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$849.60
|
| Rate for Payer: Humana ChoiceCare |
$245.44
|
| Rate for Payer: Multiplan All |
$859.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$566.40
|
| Rate for Payer: OMNI Networks Commercial |
$660.80
|
| Rate for Payer: One Health Plan PPO/POS |
$849.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$896.80
|
| Rate for Payer: Three Rivers Provider Network All |
$708.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$830.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$236.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$877.92
|
| Rate for Payer: Zelis Auto |
$377.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$472.00
|
|
|
IMPLT SCREW LOCKING 3.5 X 32MM
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$390.50 |
| Max. Negotiated Rate |
$1,483.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$937.20
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cigna Commercial |
$1,327.70
|
| Rate for Payer: First Health Commercial |
$1,405.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,405.80
|
| Rate for Payer: GEHA Commercial |
$1,249.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,405.80
|
| Rate for Payer: Humana ChoiceCare |
$406.12
|
| Rate for Payer: Multiplan All |
$1,421.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$937.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,093.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,405.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,483.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,171.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,374.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$390.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,452.66
|
| Rate for Payer: Zelis Auto |
$624.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$781.00
|
|
|
IMPLT SCREW LOCKING 3.5 X 32MM
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.80 |
| Max. Negotiated Rate |
$1,483.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,249.60
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cigna Commercial |
$1,327.70
|
| Rate for Payer: First Health Commercial |
$1,405.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,405.80
|
| Rate for Payer: GEHA Commercial |
$1,093.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,405.80
|
| Rate for Payer: Multiplan All |
$1,421.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,093.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,405.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,483.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,171.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,452.66
|
| Rate for Payer: Zelis Auto |
$624.80
|
|
|
IMPLT SCREW LOCKING 3.5X32MM
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.60
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$491.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
|
|
IMPLT SCREW LOCKING 3.5X32MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001516
|
|
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 3.5X32MM
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.40 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.80
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
|
|
IMPLT SCREW LOCKING 3.5X32MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001516
|
|
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 3.5X32MM
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$561.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Humana ChoiceCare |
$182.52
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$421.20
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$617.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$351.00
|
|
|
IMPLT SCREW LOCKING 3.5X32MM
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$300.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Humana ChoiceCare |
$97.76
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$225.60
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$330.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$188.00
|
|
