|
IMPLT SCREW LOCKING 3.5X44MM
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006302
|
|
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 3.5 X 46MM
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003519
|
|
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 46MM
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003519
|
|
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 3.5X46MM
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000580
|
|
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 3.5X46MM
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006303
|
|
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 3.5X46MM
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006303
|
|
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
|
|
|
IMPLT SCREW LOCKING 3.5X46MM
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000580
|
|
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 3.5X48MM
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006304
|
|
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
|
|
|
IMPLT SCREW LOCKING 3.5X48MM
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006304
|
|
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 3.5 X 50MM
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003515
|
|
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 3.5 X 50MM
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003515
|
|
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 3.5X50MM
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006305
|
|
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 3.5X50MM
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.20 |
| Max. Negotiated Rate |
$848.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$714.40
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cigna Commercial |
$759.05
|
| Rate for Payer: First Health Commercial |
$803.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$803.70
|
| Rate for Payer: GEHA Commercial |
$625.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$803.70
|
| Rate for Payer: Multiplan All |
$812.63
|
| Rate for Payer: OMNI Networks Commercial |
$625.10
|
| Rate for Payer: One Health Plan PPO/POS |
$803.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$848.35
|
| Rate for Payer: Three Rivers Provider Network All |
$669.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$830.49
|
| Rate for Payer: Zelis Auto |
$357.20
|
|
|
IMPLT SCREW LOCKING 3.5X50MM
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000928
|
|
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 3.5X50MM
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006305
|
|
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 3.5X50MM
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000928
|
|
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 3.5X50MM
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.25 |
| Max. Negotiated Rate |
$848.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$535.80
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cigna Commercial |
$759.05
|
| Rate for Payer: First Health Commercial |
$803.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$803.70
|
| Rate for Payer: GEHA Commercial |
$714.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$803.70
|
| Rate for Payer: Humana ChoiceCare |
$232.18
|
| Rate for Payer: Multiplan All |
$812.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$535.80
|
| Rate for Payer: OMNI Networks Commercial |
$625.10
|
| Rate for Payer: One Health Plan PPO/POS |
$803.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$848.35
|
| Rate for Payer: Three Rivers Provider Network All |
$669.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$785.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$830.49
|
| Rate for Payer: Zelis Auto |
$357.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$446.50
|
|
|
IMPLT SCREW LOCKING 3.5 X 55MM
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003517
|
|
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 55MM
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003517
|
|
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 3.5X55MM
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006306
|
|
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 3.5X55MM
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006306
|
|
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
|
|
|
IMPLT SCREW LOCKING 3.5 X 60MM
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003516
|
|
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 3.5 X 60MM
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003516
|
|
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 3.5X60MM
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006307
|
|
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 3.5X60MM
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006307
|
|
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
|
|
