|
IMPLT SCREW THREADED PARTIALLY
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000634
|
|
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 THREADED PARTIALLY
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000635
|
|
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 THREADED PARTIALLY
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000633
|
|
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 THREADED PARTIALLY 121814
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000637
|
|
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 THREADED PARTIALLY 121814
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000637
|
|
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 THREADED PARTIALLY 121816
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000638
|
|
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 THREADED PARTIALLY 121816
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000638
|
|
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 THREADED PARTIALLY 205.036
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.80 |
| Max. Negotiated Rate |
$1,027.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$865.60
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$919.70
|
| Rate for Payer: First Health Commercial |
$973.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$973.80
|
| Rate for Payer: GEHA Commercial |
$757.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$973.80
|
| Rate for Payer: Multiplan All |
$984.62
|
| Rate for Payer: OMNI Networks Commercial |
$757.40
|
| Rate for Payer: One Health Plan PPO/POS |
$973.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,027.90
|
| Rate for Payer: Three Rivers Provider Network All |
$811.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,006.26
|
| Rate for Payer: Zelis Auto |
$432.80
|
|
|
IMPLT SCREW THREADED PARTIALLY 205.036
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.50 |
| Max. Negotiated Rate |
$1,027.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$919.70
|
| Rate for Payer: First Health Commercial |
$973.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$973.80
|
| Rate for Payer: GEHA Commercial |
$865.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$973.80
|
| Rate for Payer: Humana ChoiceCare |
$281.32
|
| Rate for Payer: Multiplan All |
$984.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$649.20
|
| Rate for Payer: OMNI Networks Commercial |
$757.40
|
| Rate for Payer: One Health Plan PPO/POS |
$973.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,027.90
|
| Rate for Payer: Three Rivers Provider Network All |
$811.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$952.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$270.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,006.26
|
| Rate for Payer: Zelis Auto |
$432.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$541.00
|
|
|
IMPLT SCREW THREADED PARTIALLY 205.226
|
Facility
|
IP
|
$1,313.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.20 |
| Max. Negotiated Rate |
$1,247.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,050.40
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cigna Commercial |
$1,116.05
|
| Rate for Payer: First Health Commercial |
$1,181.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,181.70
|
| Rate for Payer: GEHA Commercial |
$919.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,181.70
|
| Rate for Payer: Multiplan All |
$1,194.83
|
| Rate for Payer: OMNI Networks Commercial |
$919.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,181.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,247.35
|
| Rate for Payer: Three Rivers Provider Network All |
$984.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,221.09
|
| Rate for Payer: Zelis Auto |
$525.20
|
|
|
IMPLT SCREW THREADED PARTIALLY 205.226
|
Facility
|
OP
|
$1,313.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.25 |
| Max. Negotiated Rate |
$1,247.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cigna Commercial |
$1,116.05
|
| Rate for Payer: First Health Commercial |
$1,181.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,181.70
|
| Rate for Payer: GEHA Commercial |
$1,050.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,181.70
|
| Rate for Payer: Humana ChoiceCare |
$341.38
|
| Rate for Payer: Multiplan All |
$1,194.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$787.80
|
| Rate for Payer: OMNI Networks Commercial |
$919.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,181.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,247.35
|
| Rate for Payer: Three Rivers Provider Network All |
$984.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,155.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$328.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,221.09
|
| Rate for Payer: Zelis Auto |
$525.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$656.50
|
|
|
IMPLT SCREW THREADED PARTIALLY 3.5X36MM
|
Facility
|
IP
|
$1,281.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.40 |
| Max. Negotiated Rate |
$1,216.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,024.80
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna Commercial |
$1,088.85
|
| Rate for Payer: First Health Commercial |
$1,152.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.90
|
| Rate for Payer: GEHA Commercial |
$896.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.90
|
| Rate for Payer: Multiplan All |
$1,165.71
|
| Rate for Payer: OMNI Networks Commercial |
$896.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.95
|
| Rate for Payer: Three Rivers Provider Network All |
$960.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,191.33
|
| Rate for Payer: Zelis Auto |
$512.40
|
|
|
IMPLT SCREW THREADED PARTIALLY 3.5X36MM
|
Facility
|
OP
|
$1,281.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.25 |
| Max. Negotiated Rate |
$1,216.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna Commercial |
$1,088.85
|
| Rate for Payer: First Health Commercial |
$1,152.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.90
|
| Rate for Payer: GEHA Commercial |
$1,024.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.90
|
| Rate for Payer: Humana ChoiceCare |
$333.06
|
| Rate for Payer: Multiplan All |
$1,165.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$768.60
|
| Rate for Payer: OMNI Networks Commercial |
$896.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.95
|
| Rate for Payer: Three Rivers Provider Network All |
$960.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,127.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,191.33
|
| Rate for Payer: Zelis Auto |
$512.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$640.50
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X20MM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X20MM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X20MM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X20MM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X22MM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X22MM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X24MM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X24MM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X24MM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X24MM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X24MM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X24MM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
