|
IMPLT SCREW OSTEOPENIA 5.0X16MM
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$888.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$748.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| Rate for Payer: Humana ChoiceCare |
$243.10
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$561.00
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$822.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$233.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: Zelis Auto |
$374.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$467.50
|
|
|
IMPLT SCREW OSTEOPENIA 5.0X18MM
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$888.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$748.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$654.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: Zelis Auto |
$374.00
|
|
|
IMPLT SCREW OSTEOPENIA 5.0X18MM
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$888.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$748.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| Rate for Payer: Humana ChoiceCare |
$243.10
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$561.00
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$822.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$233.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: Zelis Auto |
$374.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$467.50
|
|
|
IMPLT SCREW OSTEOPENIA 5.0X36
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW OSTEOPENIA 5.0X36
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW OSTEOPENIA F-T 5.0X16MM
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$132.08
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$304.80
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$447.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$254.00
|
|
|
IMPLT SCREW OSTEOPENIA F-T 5.0X16MM
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$406.40
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
|
|
IMPLT SCREW OSTEOPENIA F-T 5.0X26MM
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$531.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$447.20
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$391.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| Rate for Payer: Multiplan All |
$508.69
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$531.05
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$519.87
|
| Rate for Payer: Zelis Auto |
$223.60
|
|
|
IMPLT SCREW OSTEOPENIA F-T 5.0X26MM
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$531.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$447.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| Rate for Payer: Humana ChoiceCare |
$145.34
|
| Rate for Payer: Multiplan All |
$508.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$335.40
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$531.05
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$519.87
|
| Rate for Payer: Zelis Auto |
$223.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.50
|
|
|
IMPLT SCREW OSTEOPENIA P-T 5.0X32MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW OSTEOPENIA P-T 5.0X32MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW PANTHER PYTHON LEFT
|
Facility
|
IP
|
$5,550.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,220.00 |
| Max. Negotiated Rate |
$5,272.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,440.00
|
| Rate for Payer: Cash Price |
$3,330.00
|
| Rate for Payer: Cash Price |
$3,330.00
|
| Rate for Payer: Cigna Commercial |
$4,717.50
|
| Rate for Payer: First Health Commercial |
$4,995.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,995.00
|
| Rate for Payer: GEHA Commercial |
$3,885.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,995.00
|
| Rate for Payer: Multiplan All |
$5,050.50
|
| Rate for Payer: OMNI Networks Commercial |
$3,885.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,995.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,272.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,162.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,161.50
|
| Rate for Payer: Zelis Auto |
$2,220.00
|
|
|
IMPLT SCREW PANTHER PYTHON LEFT
|
Facility
|
OP
|
$5,550.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$5,272.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,330.00
|
| Rate for Payer: Cash Price |
$3,330.00
|
| Rate for Payer: Cash Price |
$3,330.00
|
| Rate for Payer: Cigna Commercial |
$4,717.50
|
| Rate for Payer: First Health Commercial |
$4,995.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,995.00
|
| Rate for Payer: GEHA Commercial |
$4,440.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,995.00
|
| Rate for Payer: Humana ChoiceCare |
$1,443.00
|
| Rate for Payer: Multiplan All |
$5,050.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,330.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,885.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,995.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,272.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,162.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,884.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,387.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,161.50
|
| Rate for Payer: Zelis Auto |
$2,220.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,775.00
|
|
|
IMPLT SCREW PARTIALLY THREADED 205.028
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.25 |
| Max. Negotiated Rate |
$1,076.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$679.80
|
| Rate for Payer: Cash Price |
$679.80
|
| Rate for Payer: Cash Price |
$679.80
|
| Rate for Payer: Cigna Commercial |
$963.05
|
| Rate for Payer: First Health Commercial |
$1,019.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,019.70
|
| Rate for Payer: GEHA Commercial |
$906.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,019.70
|
| Rate for Payer: Humana ChoiceCare |
$294.58
|
| Rate for Payer: Multiplan All |
$1,031.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$679.80
|
| Rate for Payer: OMNI Networks Commercial |
$793.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,019.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,076.35
|
| Rate for Payer: Three Rivers Provider Network All |
$849.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$997.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$283.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,053.69
|
| Rate for Payer: Zelis Auto |
$453.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$566.50
|
|
|
IMPLT SCREW PARTIALLY THREADED 205.028
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.20 |
| Max. Negotiated Rate |
$1,076.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$906.40
|
| Rate for Payer: Cash Price |
$679.80
|
| Rate for Payer: Cash Price |
$679.80
|
| Rate for Payer: Cigna Commercial |
$963.05
|
| Rate for Payer: First Health Commercial |
$1,019.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,019.70
|
| Rate for Payer: GEHA Commercial |
$793.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,019.70
|
| Rate for Payer: Multiplan All |
$1,031.03
|
| Rate for Payer: OMNI Networks Commercial |
$793.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,019.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,076.35
|
| Rate for Payer: Three Rivers Provider Network All |
$849.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,053.69
|
| Rate for Payer: Zelis Auto |
$453.20
|
|
|
IMPLT SCREW PART THREADED 5.0X50MM
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.60
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$85.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
|
|
IMPLT SCREW PART THREADED 5.0X50MM
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$31.72
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$73.20
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$107.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.00
|
|
|
IMPLT SCREW PART THREADED 8.0X60MM
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$1,159.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$976.80
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna Commercial |
$1,037.85
|
| Rate for Payer: First Health Commercial |
$1,098.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,098.90
|
| Rate for Payer: GEHA Commercial |
$854.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,098.90
|
| Rate for Payer: Multiplan All |
$1,111.11
|
| Rate for Payer: OMNI Networks Commercial |
$854.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,098.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,159.95
|
| Rate for Payer: Three Rivers Provider Network All |
$915.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,135.53
|
| Rate for Payer: Zelis Auto |
$488.40
|
|
|
IMPLT SCREW PART THREADED 8.0X60MM
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.25 |
| Max. Negotiated Rate |
$1,159.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna Commercial |
$1,037.85
|
| Rate for Payer: First Health Commercial |
$1,098.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,098.90
|
| Rate for Payer: GEHA Commercial |
$976.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,098.90
|
| Rate for Payer: Humana ChoiceCare |
$317.46
|
| Rate for Payer: Multiplan All |
$1,111.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$732.60
|
| Rate for Payer: OMNI Networks Commercial |
$854.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,098.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,159.95
|
| Rate for Payer: Three Rivers Provider Network All |
$915.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,074.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$305.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,135.53
|
| Rate for Payer: Zelis Auto |
$488.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$610.50
|
|
|
IMPLT SCREW PEEK 7X20MM
|
Facility
|
IP
|
$1,422.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.80 |
| Max. Negotiated Rate |
$1,350.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,137.60
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$1,208.70
|
| Rate for Payer: First Health Commercial |
$1,279.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,279.80
|
| Rate for Payer: GEHA Commercial |
$995.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,279.80
|
| Rate for Payer: Multiplan All |
$1,294.02
|
| Rate for Payer: OMNI Networks Commercial |
$995.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,279.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,350.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,322.46
|
| Rate for Payer: Zelis Auto |
$568.80
|
|
|
IMPLT SCREW PEEK 7X20MM
|
Facility
|
OP
|
$1,422.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$1,350.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$1,208.70
|
| Rate for Payer: First Health Commercial |
$1,279.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,279.80
|
| Rate for Payer: GEHA Commercial |
$1,137.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,279.80
|
| Rate for Payer: Humana ChoiceCare |
$369.72
|
| Rate for Payer: Multiplan All |
$1,294.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$853.20
|
| Rate for Payer: OMNI Networks Commercial |
$995.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,279.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,350.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,251.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,322.46
|
| Rate for Payer: Zelis Auto |
$568.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$711.00
|
|
|
IMPLT SCREW PEEK 8X20MM
|
Facility
|
OP
|
$1,422.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$1,350.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$1,208.70
|
| Rate for Payer: First Health Commercial |
$1,279.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,279.80
|
| Rate for Payer: GEHA Commercial |
$1,137.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,279.80
|
| Rate for Payer: Humana ChoiceCare |
$369.72
|
| Rate for Payer: Multiplan All |
$1,294.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$853.20
|
| Rate for Payer: OMNI Networks Commercial |
$995.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,279.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,350.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,251.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,322.46
|
| Rate for Payer: Zelis Auto |
$568.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$711.00
|
|
|
IMPLT SCREW PEEK 8X20MM
|
Facility
|
IP
|
$1,422.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.80 |
| Max. Negotiated Rate |
$1,350.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,137.60
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$1,208.70
|
| Rate for Payer: First Health Commercial |
$1,279.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,279.80
|
| Rate for Payer: GEHA Commercial |
$995.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,279.80
|
| Rate for Payer: Multiplan All |
$1,294.02
|
| Rate for Payer: OMNI Networks Commercial |
$995.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,279.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,350.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,322.46
|
| Rate for Payer: Zelis Auto |
$568.80
|
|
|
IMPLT SCREW PEEK 8X30MM
|
Facility
|
OP
|
$1,422.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$1,350.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$1,208.70
|
| Rate for Payer: First Health Commercial |
$1,279.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,279.80
|
| Rate for Payer: GEHA Commercial |
$1,137.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,279.80
|
| Rate for Payer: Humana ChoiceCare |
$369.72
|
| Rate for Payer: Multiplan All |
$1,294.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$853.20
|
| Rate for Payer: OMNI Networks Commercial |
$995.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,279.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,350.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,251.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,322.46
|
| Rate for Payer: Zelis Auto |
$568.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$711.00
|
|
|
IMPLT SCREW PEEK 8X30MM
|
Facility
|
IP
|
$1,422.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.80 |
| Max. Negotiated Rate |
$1,350.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,137.60
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$1,208.70
|
| Rate for Payer: First Health Commercial |
$1,279.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,279.80
|
| Rate for Payer: GEHA Commercial |
$995.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,279.80
|
| Rate for Payer: Multiplan All |
$1,294.02
|
| Rate for Payer: OMNI Networks Commercial |
$995.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,279.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,350.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,322.46
|
| Rate for Payer: Zelis Auto |
$568.80
|
|
