|
IMPLT SCREW SMOOTH PEG 2.0X18MM
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$540.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$472.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
|
|
IMPLT SCREW S/N 2.5X10MM LOCKING
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$676.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$591.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
|
|
IMPLT SCREW S/N 2.5X10MM LOCKING
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.25 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$676.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Humana ChoiceCare |
$219.70
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$507.00
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$743.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$211.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$422.50
|
|
|
IMPLT SCREW S/N 2.5X22 LOCKING
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.25 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$676.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Humana ChoiceCare |
$219.70
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$507.00
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$743.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$211.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$422.50
|
|
|
IMPLT SCREW S/N 2.5X22 LOCKING
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$676.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$591.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
|
|
IMPLT SCREW SN 2.7MM
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$146.40
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$128.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
|
|
IMPLT SCREW SN 2.7MM
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$146.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Humana ChoiceCare |
$47.58
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$109.80
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$161.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$91.50
|
|
|
IMPLT SCREW S/N 3.5X10 LOCKING
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.60
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$316.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
|
|
IMPLT SCREW S/N 3.5X10 LOCKING
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$361.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Humana ChoiceCare |
$117.52
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$271.20
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$397.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$113.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.00
|
|
|
IMPLT SCREW S/N 3.5X12 LOCKING
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.60
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$316.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
|
|
IMPLT SCREW S/N 3.5X12 LOCKING
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$361.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Humana ChoiceCare |
$117.52
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$271.20
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$397.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$113.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.00
|
|
|
IMPLT SCREW SN 40X28 MM PT
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$797.60
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$697.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
|
|
IMPLT SCREW SN 40X28 MM PT
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Humana ChoiceCare |
$259.22
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$598.20
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$877.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$249.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.50
|
|
|
IMPLT SCREW SN 4.0X40MM PT
|
Facility
|
IP
|
$1,403.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.20 |
| Max. Negotiated Rate |
$1,332.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,122.40
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cigna Commercial |
$1,192.55
|
| Rate for Payer: First Health Commercial |
$1,262.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,262.70
|
| Rate for Payer: GEHA Commercial |
$982.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,262.70
|
| Rate for Payer: Multiplan All |
$1,276.73
|
| Rate for Payer: OMNI Networks Commercial |
$982.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,262.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,332.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,052.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,304.79
|
| Rate for Payer: Zelis Auto |
$561.20
|
|
|
IMPLT SCREW SN 4.0X40MM PT
|
Facility
|
OP
|
$1,403.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.75 |
| Max. Negotiated Rate |
$1,332.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.80
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cigna Commercial |
$1,192.55
|
| Rate for Payer: First Health Commercial |
$1,262.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,262.70
|
| Rate for Payer: GEHA Commercial |
$1,122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,262.70
|
| Rate for Payer: Humana ChoiceCare |
$364.78
|
| Rate for Payer: Multiplan All |
$1,276.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$841.80
|
| Rate for Payer: OMNI Networks Commercial |
$982.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,262.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,332.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,052.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,234.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$350.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,304.79
|
| Rate for Payer: Zelis Auto |
$561.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$701.50
|
|
|
IMPLT SCREW SN CANN 4X24 PT
|
Facility
|
OP
|
$989.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.25 |
| Max. Negotiated Rate |
$939.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$593.40
|
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Cigna Commercial |
$840.65
|
| Rate for Payer: First Health Commercial |
$890.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$890.10
|
| Rate for Payer: GEHA Commercial |
$791.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$890.10
|
| Rate for Payer: Humana ChoiceCare |
$257.14
|
| Rate for Payer: Multiplan All |
$899.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$593.40
|
| Rate for Payer: OMNI Networks Commercial |
$692.30
|
| Rate for Payer: One Health Plan PPO/POS |
$890.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$939.55
|
| Rate for Payer: Three Rivers Provider Network All |
$741.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$870.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$247.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$919.77
|
| Rate for Payer: Zelis Auto |
$395.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$494.50
|
|
|
IMPLT SCREW SN CANN 4X24 PT
|
Facility
|
IP
|
$989.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$395.60 |
| Max. Negotiated Rate |
$939.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$791.20
|
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Cigna Commercial |
$840.65
|
| Rate for Payer: First Health Commercial |
$890.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$890.10
|
| Rate for Payer: GEHA Commercial |
$692.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$890.10
|
| Rate for Payer: Multiplan All |
$899.99
|
| Rate for Payer: OMNI Networks Commercial |
$692.30
|
| Rate for Payer: One Health Plan PPO/POS |
$890.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$939.55
|
| Rate for Payer: Three Rivers Provider Network All |
$741.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$919.77
|
| Rate for Payer: Zelis Auto |
$395.60
|
|
|
IMPLT SCREW SN CANN 6.5X60 PT
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.60 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,015.20
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$888.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
|
|
IMPLT SCREW SN CANN 6.5X60 PT
|
Facility
|
OP
|
$1,269.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.25 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$1,015.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Humana ChoiceCare |
$329.94
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$761.40
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,116.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$317.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$634.50
|
|
|
IMPLT SCREW SN FT 4X35 222835
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$844.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$738.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
|
|
IMPLT SCREW SN FT 4X35 222835
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.75 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$844.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Humana ChoiceCare |
$274.30
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$633.00
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$928.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.50
|
|
|
IMPLT SCREW SN FT 4X55 222855
|
Facility
|
IP
|
$1,216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.40 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$972.80
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: First Health Commercial |
$1,094.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,094.40
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,094.40
|
| Rate for Payer: Multiplan All |
$1,106.56
|
| Rate for Payer: OMNI Networks Commercial |
$851.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,094.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,155.20
|
| Rate for Payer: Three Rivers Provider Network All |
$912.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,130.88
|
| Rate for Payer: Zelis Auto |
$486.40
|
|
|
IMPLT SCREW SN FT 4X55 222855
|
Facility
|
OP
|
$1,216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: First Health Commercial |
$1,094.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,094.40
|
| Rate for Payer: GEHA Commercial |
$972.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,094.40
|
| Rate for Payer: Humana ChoiceCare |
$316.16
|
| Rate for Payer: Multiplan All |
$1,106.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$729.60
|
| Rate for Payer: OMNI Networks Commercial |
$851.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,094.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,155.20
|
| Rate for Payer: Three Rivers Provider Network All |
$912.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,070.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,130.88
|
| Rate for Payer: Zelis Auto |
$486.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$608.00
|
|
|
IMPLT SCREW SN PERI4.0X10
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.50 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: First Health Commercial |
$225.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.00
|
| Rate for Payer: GEHA Commercial |
$200.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.00
|
| Rate for Payer: Humana ChoiceCare |
$65.00
|
| Rate for Payer: Multiplan All |
$227.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$150.00
|
| Rate for Payer: OMNI Networks Commercial |
$175.00
|
| Rate for Payer: One Health Plan PPO/POS |
$225.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$237.50
|
| Rate for Payer: Three Rivers Provider Network All |
$187.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$220.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$232.50
|
| Rate for Payer: Zelis Auto |
$100.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$125.00
|
|
|
IMPLT SCREW SN PERI4.0X10
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$200.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: First Health Commercial |
$225.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.00
|
| Rate for Payer: GEHA Commercial |
$175.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.00
|
| Rate for Payer: Multiplan All |
$227.50
|
| Rate for Payer: OMNI Networks Commercial |
$175.00
|
| Rate for Payer: One Health Plan PPO/POS |
$225.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$237.50
|
| Rate for Payer: Three Rivers Provider Network All |
$187.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$232.50
|
| Rate for Payer: Zelis Auto |
$100.00
|
|
