|
IMPLT SCREW PK 6X25MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW PK 7X20MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW PK 7X20MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW PK 7X25MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW PK 7X25MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW PK 7X30MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW PK 7X30MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW PK 8X20MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW PK 8X20MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW PK 8X25MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW PK 8X25MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW PK 8X30MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW PK 8X30MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW PK 8X35MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW PK 8X35MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW PK 9X20MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW PK 9X20MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW PK 9X25MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW PK 9X25MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW PK 9X30MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW PK 9X30MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW PLATE GAP 6.5MM
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002583
|
|
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 PLATE GAP 6.5MM
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002583
|
|
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 PLATE RESTORATION 6.5X15MM
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.40 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$600.80
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cigna Commercial |
$638.35
|
| Rate for Payer: First Health Commercial |
$675.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.90
|
| Rate for Payer: GEHA Commercial |
$525.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.90
|
| Rate for Payer: Multiplan All |
$683.41
|
| Rate for Payer: OMNI Networks Commercial |
$525.70
|
| Rate for Payer: One Health Plan PPO/POS |
$675.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$713.45
|
| Rate for Payer: Three Rivers Provider Network All |
$563.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$698.43
|
| Rate for Payer: Zelis Auto |
$300.40
|
|
|
IMPLT SCREW PLATE RESTORATION 6.5X15MM
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.75 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cigna Commercial |
$638.35
|
| Rate for Payer: First Health Commercial |
$675.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.90
|
| Rate for Payer: GEHA Commercial |
$600.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.90
|
| Rate for Payer: Humana ChoiceCare |
$195.26
|
| Rate for Payer: Multiplan All |
$683.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$450.60
|
| Rate for Payer: OMNI Networks Commercial |
$525.70
|
| Rate for Payer: One Health Plan PPO/POS |
$675.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$713.45
|
| Rate for Payer: Three Rivers Provider Network All |
$563.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$660.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$187.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$698.43
|
| Rate for Payer: Zelis Auto |
$300.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$375.50
|
|
