|
IMPLT SCREW LOCKING NON 2.7X20MM
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.75 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$456.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Humana ChoiceCare |
$148.46
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$342.60
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$502.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$285.50
|
|
|
IMPLT SCREW LOCKING NON 2.7X22MM
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$696.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Humana ChoiceCare |
$226.46
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$522.60
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$766.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$217.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$435.50
|
|
|
IMPLT SCREW LOCKING NON 2.7X22MM
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.75 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$456.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Humana ChoiceCare |
$148.46
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$342.60
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$502.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$285.50
|
|
|
IMPLT SCREW LOCKING NON 2.7X22MM
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.40 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.80
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$399.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
|
|
IMPLT SCREW LOCKING NON 2.7X22MM
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.80
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$609.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
|
|
IMPLT SCREW LOCKING NON 2.7X24MM
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.75 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$456.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Humana ChoiceCare |
$148.46
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$342.60
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$502.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$285.50
|
|
|
IMPLT SCREW LOCKING NON 2.7X24MM
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.40 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.80
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$399.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
|
|
IMPLT SCREW LOCKING NON 2.7X26MM
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.75 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$456.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Humana ChoiceCare |
$148.46
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$342.60
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$502.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$285.50
|
|
|
IMPLT SCREW LOCKING NON 2.7X26MM
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.40 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.80
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$399.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
|
|
IMPLT SCREW LOCKING NON 2.7X30MM
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.75 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$456.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Humana ChoiceCare |
$148.46
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$342.60
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$502.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$285.50
|
|
|
IMPLT SCREW LOCKING NON 2.7X30MM
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$696.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Humana ChoiceCare |
$226.46
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$522.60
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$766.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$217.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$435.50
|
|
|
IMPLT SCREW LOCKING NON 2.7X30MM
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.80
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$609.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
|
|
IMPLT SCREW LOCKING NON 2.7X30MM
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.40 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.80
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$399.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
|
|
IMPLT SCREW LOCKING NON 2.7X32MM
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.40 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.80
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$399.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
|
|
IMPLT SCREW LOCKING NON 2.7X32MM
|
Facility
|
OP
|
$685.00
|
|
| Hospital Charge Code |
7006195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$548.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Humana ChoiceCare |
$178.10
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$411.00
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$602.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$342.50
|
|
|
IMPLT SCREW LOCKING NON 2.7X32MM
|
Facility
|
IP
|
$685.00
|
|
| Hospital Charge Code |
7006195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$479.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
|
|
IMPLT SCREW LOCKING NON 2.7X32MM
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.75 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$456.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Humana ChoiceCare |
$148.46
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$342.60
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$502.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$285.50
|
|
|
IMPLT SCREW LOCKING NON 3.5X20M
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.25 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Humana ChoiceCare |
$158.34
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$365.40
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$535.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$304.50
|
|
|
IMPLT SCREW LOCKING NON 3.5X20M
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$487.20
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$426.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: Zelis Auto |
$243.60
|
|
|
IMPLT SCREW LOCKING NON 3.5X28MM
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$420.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$367.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
|
|
IMPLT SCREW LOCKING NON 3.5X28MM
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Humana ChoiceCare |
$136.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$315.00
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$462.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$131.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$262.50
|
|
|
IMPLT SCREW LOCKING NON 3.5X36MM
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$484.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$423.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
|
|
IMPLT SCREW LOCKING NON 3.5X36MM
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.25 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$484.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Humana ChoiceCare |
$157.30
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$363.00
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$532.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.50
|
|
|
IMPLT SCREW LOCKING NON 3.5X40MM
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$484.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$423.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
|
|
IMPLT SCREW LOCKING NON 3.5X40MM
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.25 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$484.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Humana ChoiceCare |
$157.30
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$363.00
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$532.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.50
|
|
