|
IMPLT SCREW LOCKING 4.75X35MM
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.60 |
| Max. Negotiated Rate |
$1,020.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$859.20
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cigna Commercial |
$912.90
|
| Rate for Payer: First Health Commercial |
$966.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$966.60
|
| Rate for Payer: GEHA Commercial |
$751.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$966.60
|
| Rate for Payer: Multiplan All |
$977.34
|
| Rate for Payer: OMNI Networks Commercial |
$751.80
|
| Rate for Payer: One Health Plan PPO/POS |
$966.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,020.30
|
| Rate for Payer: Three Rivers Provider Network All |
$805.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$998.82
|
| Rate for Payer: Zelis Auto |
$429.60
|
|
|
IMPLT SCREW LOCKING 4.75X40MM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
|
|
IMPLT SCREW LOCKING 4.75X40MM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$171.60
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$396.00
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$580.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$330.00
|
|
|
IMPLT SCREW LOCKING 4.75X45MM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
|
|
IMPLT SCREW LOCKING 4.75X45MM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$171.60
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$396.00
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$580.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$330.00
|
|
|
IMPLT SCREW LOCKING 4X36MM
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.75 |
| Max. Negotiated Rate |
$975.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$616.20
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cigna Commercial |
$872.95
|
| Rate for Payer: First Health Commercial |
$924.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$924.30
|
| Rate for Payer: GEHA Commercial |
$821.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$924.30
|
| Rate for Payer: Humana ChoiceCare |
$267.02
|
| Rate for Payer: Multiplan All |
$934.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$616.20
|
| Rate for Payer: OMNI Networks Commercial |
$718.90
|
| Rate for Payer: One Health Plan PPO/POS |
$924.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$975.65
|
| Rate for Payer: Three Rivers Provider Network All |
$770.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$903.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$256.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$955.11
|
| Rate for Payer: Zelis Auto |
$410.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$513.50
|
|
|
IMPLT SCREW LOCKING 4X36MM
|
Facility
|
IP
|
$1,027.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.80 |
| Max. Negotiated Rate |
$975.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$821.60
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cigna Commercial |
$872.95
|
| Rate for Payer: First Health Commercial |
$924.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$924.30
|
| Rate for Payer: GEHA Commercial |
$718.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$924.30
|
| Rate for Payer: Multiplan All |
$934.57
|
| Rate for Payer: OMNI Networks Commercial |
$718.90
|
| Rate for Payer: One Health Plan PPO/POS |
$924.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$975.65
|
| Rate for Payer: Three Rivers Provider Network All |
$770.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$955.11
|
| Rate for Payer: Zelis Auto |
$410.80
|
|
|
IMPLT SCREW LOCKING 5.0X20MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW LOCKING 5.0X20MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW LOCKING 5.0X25MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW LOCKING 5.0X25MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW LOCKING 5.0X28MM
|
Facility
|
OP
|
$1,148.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$1,090.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$688.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cigna Commercial |
$975.80
|
| Rate for Payer: First Health Commercial |
$1,033.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,033.20
|
| Rate for Payer: GEHA Commercial |
$918.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,033.20
|
| Rate for Payer: Humana ChoiceCare |
$298.48
|
| Rate for Payer: Multiplan All |
$1,044.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$688.80
|
| Rate for Payer: OMNI Networks Commercial |
$803.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,033.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,090.60
|
| Rate for Payer: Three Rivers Provider Network All |
$861.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,010.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$287.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,067.64
|
| Rate for Payer: Zelis Auto |
$459.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$574.00
|
|
|
IMPLT SCREW LOCKING 5.0X28MM
|
Facility
|
IP
|
$1,148.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.20 |
| Max. Negotiated Rate |
$1,090.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$918.40
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cigna Commercial |
$975.80
|
| Rate for Payer: First Health Commercial |
$1,033.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,033.20
|
| Rate for Payer: GEHA Commercial |
$803.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,033.20
|
| Rate for Payer: Multiplan All |
$1,044.68
|
| Rate for Payer: OMNI Networks Commercial |
$803.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,033.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,090.60
|
| Rate for Payer: Three Rivers Provider Network All |
$861.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,067.64
|
| Rate for Payer: Zelis Auto |
$459.20
|
|
|
IMPLT SCREW LOCKING 5.0X30MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW LOCKING 5.0X30MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW LOCKING 5.0X32MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW LOCKING 5.0X32MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW LOCKING 5.0X34MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW LOCKING 5.0X34MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW LOCKING 5.0X42MM
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$260.50 |
| Max. Negotiated Rate |
$989.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$625.20
|
| Rate for Payer: Cash Price |
$625.20
|
| Rate for Payer: Cash Price |
$625.20
|
| Rate for Payer: Cigna Commercial |
$885.70
|
| Rate for Payer: First Health Commercial |
$937.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$937.80
|
| Rate for Payer: GEHA Commercial |
$833.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$937.80
|
| Rate for Payer: Humana ChoiceCare |
$270.92
|
| Rate for Payer: Multiplan All |
$948.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$625.20
|
| Rate for Payer: OMNI Networks Commercial |
$729.40
|
| Rate for Payer: One Health Plan PPO/POS |
$937.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$989.90
|
| Rate for Payer: Three Rivers Provider Network All |
$781.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$916.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$260.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$969.06
|
| Rate for Payer: Zelis Auto |
$416.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$521.00
|
|
|
IMPLT SCREW LOCKING 5.0X42MM
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.80 |
| Max. Negotiated Rate |
$989.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$833.60
|
| Rate for Payer: Cash Price |
$625.20
|
| Rate for Payer: Cash Price |
$625.20
|
| Rate for Payer: Cigna Commercial |
$885.70
|
| Rate for Payer: First Health Commercial |
$937.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$937.80
|
| Rate for Payer: GEHA Commercial |
$729.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$937.80
|
| Rate for Payer: Multiplan All |
$948.22
|
| Rate for Payer: OMNI Networks Commercial |
$729.40
|
| Rate for Payer: One Health Plan PPO/POS |
$937.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$989.90
|
| Rate for Payer: Three Rivers Provider Network All |
$781.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$969.06
|
| Rate for Payer: Zelis Auto |
$416.80
|
|
|
IMPLT SCREW LOCKING 5.0X44MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW LOCKING 5.0X44MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW LOCKING 5.0X50MM
|
Facility
|
OP
|
$1,148.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$1,090.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$688.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cigna Commercial |
$975.80
|
| Rate for Payer: First Health Commercial |
$1,033.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,033.20
|
| Rate for Payer: GEHA Commercial |
$918.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,033.20
|
| Rate for Payer: Humana ChoiceCare |
$298.48
|
| Rate for Payer: Multiplan All |
$1,044.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$688.80
|
| Rate for Payer: OMNI Networks Commercial |
$803.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,033.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,090.60
|
| Rate for Payer: Three Rivers Provider Network All |
$861.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,010.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$287.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,067.64
|
| Rate for Payer: Zelis Auto |
$459.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$574.00
|
|
|
IMPLT SCREW LOCKING 5.0X50MM
|
Facility
|
IP
|
$1,148.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.20 |
| Max. Negotiated Rate |
$1,090.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$918.40
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cigna Commercial |
$975.80
|
| Rate for Payer: First Health Commercial |
$1,033.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,033.20
|
| Rate for Payer: GEHA Commercial |
$803.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,033.20
|
| Rate for Payer: Multiplan All |
$1,044.68
|
| Rate for Payer: OMNI Networks Commercial |
$803.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,033.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,090.60
|
| Rate for Payer: Three Rivers Provider Network All |
$861.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,067.64
|
| Rate for Payer: Zelis Auto |
$459.20
|
|
