|
IMPLT SCREW VARIAX 2.7 X 8MM
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$470.40
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$411.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
|
|
IMPLT SCREW WRIST 18MM
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$1,406.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,184.00
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$1,258.00
|
| Rate for Payer: First Health Commercial |
$1,332.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,332.00
|
| Rate for Payer: GEHA Commercial |
$1,036.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,332.00
|
| Rate for Payer: Multiplan All |
$1,346.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,036.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,332.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,406.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,110.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,376.40
|
| Rate for Payer: Zelis Auto |
$592.00
|
|
|
IMPLT SCREW WRIST 18MM
|
Facility
|
OP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$370.00 |
| Max. Negotiated Rate |
$1,406.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$888.00
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$1,258.00
|
| Rate for Payer: First Health Commercial |
$1,332.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,332.00
|
| Rate for Payer: GEHA Commercial |
$1,184.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,332.00
|
| Rate for Payer: Humana ChoiceCare |
$384.80
|
| Rate for Payer: Multiplan All |
$1,346.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$888.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,036.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,332.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,406.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,110.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,302.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$370.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,376.40
|
| Rate for Payer: Zelis Auto |
$592.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$740.00
|
|
|
IMPLT SCREW WRIST 30MM
|
Facility
|
OP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$370.00 |
| Max. Negotiated Rate |
$1,406.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$888.00
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$1,258.00
|
| Rate for Payer: First Health Commercial |
$1,332.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,332.00
|
| Rate for Payer: GEHA Commercial |
$1,184.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,332.00
|
| Rate for Payer: Humana ChoiceCare |
$384.80
|
| Rate for Payer: Multiplan All |
$1,346.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$888.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,036.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,332.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,406.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,110.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,302.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$370.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,376.40
|
| Rate for Payer: Zelis Auto |
$592.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$740.00
|
|
|
IMPLT SCREW WRIST 30MM
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$1,406.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,184.00
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$1,258.00
|
| Rate for Payer: First Health Commercial |
$1,332.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,332.00
|
| Rate for Payer: GEHA Commercial |
$1,036.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,332.00
|
| Rate for Payer: Multiplan All |
$1,346.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,036.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,332.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,406.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,110.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,376.40
|
| Rate for Payer: Zelis Auto |
$592.00
|
|
|
IMPLT SCREW Z 7.0 CANN 55 ST
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.75 |
| Max. Negotiated Rate |
$1,028.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cigna Commercial |
$920.55
|
| Rate for Payer: First Health Commercial |
$974.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$974.70
|
| Rate for Payer: GEHA Commercial |
$866.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$974.70
|
| Rate for Payer: Humana ChoiceCare |
$281.58
|
| Rate for Payer: Multiplan All |
$985.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$649.80
|
| Rate for Payer: OMNI Networks Commercial |
$758.10
|
| Rate for Payer: One Health Plan PPO/POS |
$974.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,028.85
|
| Rate for Payer: Three Rivers Provider Network All |
$812.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$953.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$270.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,007.19
|
| Rate for Payer: Zelis Auto |
$433.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$541.50
|
|
|
IMPLT SCREW Z 7.0 CANN 55 ST
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.20 |
| Max. Negotiated Rate |
$1,028.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$866.40
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cigna Commercial |
$920.55
|
| Rate for Payer: First Health Commercial |
$974.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$974.70
|
| Rate for Payer: GEHA Commercial |
$758.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$974.70
|
| Rate for Payer: Multiplan All |
$985.53
|
| Rate for Payer: OMNI Networks Commercial |
$758.10
|
| Rate for Payer: One Health Plan PPO/POS |
$974.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,028.85
|
| Rate for Payer: Three Rivers Provider Network All |
$812.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,007.19
|
| Rate for Payer: Zelis Auto |
$433.20
|
|
|
IMPLT SCREW Z 7.0 CANN ST
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.75 |
| Max. Negotiated Rate |
$1,028.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cigna Commercial |
$920.55
|
| Rate for Payer: First Health Commercial |
$974.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$974.70
|
| Rate for Payer: GEHA Commercial |
$866.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$974.70
|
| Rate for Payer: Humana ChoiceCare |
$281.58
|
| Rate for Payer: Multiplan All |
$985.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$649.80
|
| Rate for Payer: OMNI Networks Commercial |
$758.10
|
| Rate for Payer: One Health Plan PPO/POS |
$974.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,028.85
|
| Rate for Payer: Three Rivers Provider Network All |
$812.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$953.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$270.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,007.19
|
| Rate for Payer: Zelis Auto |
$433.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$541.50
|
|
|
IMPLT SCREW Z 7.0 CANN ST
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.20 |
| Max. Negotiated Rate |
$1,028.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$866.40
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cigna Commercial |
$920.55
|
| Rate for Payer: First Health Commercial |
$974.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$974.70
|
| Rate for Payer: GEHA Commercial |
$758.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$974.70
|
| Rate for Payer: Multiplan All |
$985.53
|
| Rate for Payer: OMNI Networks Commercial |
$758.10
|
| Rate for Payer: One Health Plan PPO/POS |
$974.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,028.85
|
| Rate for Payer: Three Rivers Provider Network All |
$812.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,007.19
|
| Rate for Payer: Zelis Auto |
$433.20
|
|
|
IMPLT SCREW Z C+T 2.7 #14
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.75 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Humana ChoiceCare |
$74.62
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$172.20
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$252.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$143.50
|
|
|
IMPLT SCREW Z C+T 2.7 #14
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$229.60
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
|
|
IMPLT SCREW ZPFX 4X55MM
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$132.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Humana ChoiceCare |
$43.16
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$99.60
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$83.00
|
|
|
IMPLT SCREW ZPFX 4X55MM
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.80
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$149.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$149.40
|
| Rate for Payer: GEHA Commercial |
$116.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$149.40
|
| Rate for Payer: Multiplan All |
$151.06
|
| Rate for Payer: OMNI Networks Commercial |
$116.20
|
| Rate for Payer: One Health Plan PPO/POS |
$149.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$157.70
|
| Rate for Payer: Three Rivers Provider Network All |
$124.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$154.38
|
| Rate for Payer: Zelis Auto |
$66.40
|
|
|
IMPLT SCREW ZSF 16 X 2.7MM 482701601
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.25 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$157.25
|
| Rate for Payer: First Health Commercial |
$166.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$166.50
|
| Rate for Payer: GEHA Commercial |
$148.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$166.50
|
| Rate for Payer: Humana ChoiceCare |
$48.10
|
| Rate for Payer: Multiplan All |
$168.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$111.00
|
| Rate for Payer: OMNI Networks Commercial |
$129.50
|
| Rate for Payer: One Health Plan PPO/POS |
$166.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$175.75
|
| Rate for Payer: Three Rivers Provider Network All |
$138.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$162.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.05
|
| Rate for Payer: Zelis Auto |
$74.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$92.50
|
|
|
IMPLT SCREW ZSF 16 X 2.7MM 482701601
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$148.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$157.25
|
| Rate for Payer: First Health Commercial |
$166.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$166.50
|
| Rate for Payer: GEHA Commercial |
$129.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$166.50
|
| Rate for Payer: Multiplan All |
$168.35
|
| Rate for Payer: OMNI Networks Commercial |
$129.50
|
| Rate for Payer: One Health Plan PPO/POS |
$166.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$175.75
|
| Rate for Payer: Three Rivers Provider Network All |
$138.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.05
|
| Rate for Payer: Zelis Auto |
$74.00
|
|
|
IMPLT SCR LCK 2.7MMX10MM EVOS T8 S-T
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$441.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Humana ChoiceCare |
$143.52
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$331.20
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$485.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$138.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$276.00
|
|
|
IMPLT SCR LCK 2.7MMX10MM EVOS T8 S-T
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.80 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$441.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$386.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
|
|
IMPLT SCR LCK 2.7MMX12MM EVOS T8 S-T
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.80 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$441.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$386.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
|
|
IMPLT SCR LCK 2.7MMX12MM EVOS T8 S-T
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$441.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Humana ChoiceCare |
$143.52
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$331.20
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$485.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$138.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$276.00
|
|
|
IMPLT SCR LCK 2.7MMX13MM EVOS S-T
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$506.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$453.05
|
| Rate for Payer: First Health Commercial |
$479.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$479.70
|
| Rate for Payer: GEHA Commercial |
$426.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$479.70
|
| Rate for Payer: Humana ChoiceCare |
$138.58
|
| Rate for Payer: Multiplan All |
$485.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$319.80
|
| Rate for Payer: OMNI Networks Commercial |
$373.10
|
| Rate for Payer: One Health Plan PPO/POS |
$479.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.35
|
| Rate for Payer: Three Rivers Provider Network All |
$399.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$469.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$133.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$495.69
|
| Rate for Payer: Zelis Auto |
$213.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$266.50
|
|
|
IMPLT SCR LCK 2.7MMX13MM EVOS S-T
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$506.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$453.05
|
| Rate for Payer: First Health Commercial |
$479.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$479.70
|
| Rate for Payer: GEHA Commercial |
$426.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$479.70
|
| Rate for Payer: Humana ChoiceCare |
$138.58
|
| Rate for Payer: Multiplan All |
$485.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$319.80
|
| Rate for Payer: OMNI Networks Commercial |
$373.10
|
| Rate for Payer: One Health Plan PPO/POS |
$479.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.35
|
| Rate for Payer: Three Rivers Provider Network All |
$399.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$469.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$133.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$495.69
|
| Rate for Payer: Zelis Auto |
$213.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$266.50
|
|
|
IMPLT SCR LCK 2.7MMX13MM EVOS S-T
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$506.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$426.40
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$453.05
|
| Rate for Payer: First Health Commercial |
$479.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$479.70
|
| Rate for Payer: GEHA Commercial |
$373.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$479.70
|
| Rate for Payer: Multiplan All |
$485.03
|
| Rate for Payer: OMNI Networks Commercial |
$373.10
|
| Rate for Payer: One Health Plan PPO/POS |
$479.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.35
|
| Rate for Payer: Three Rivers Provider Network All |
$399.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$495.69
|
| Rate for Payer: Zelis Auto |
$213.20
|
|
|
IMPLT SCR LCK 2.7MMX13MM EVOS S-T
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$506.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$426.40
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$453.05
|
| Rate for Payer: First Health Commercial |
$479.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$479.70
|
| Rate for Payer: GEHA Commercial |
$373.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$479.70
|
| Rate for Payer: Multiplan All |
$485.03
|
| Rate for Payer: OMNI Networks Commercial |
$373.10
|
| Rate for Payer: One Health Plan PPO/POS |
$479.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.35
|
| Rate for Payer: Three Rivers Provider Network All |
$399.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$495.69
|
| Rate for Payer: Zelis Auto |
$213.20
|
|
|
IMPLT SCR LCK 2.7MMX16MM EVOS T8 S-T
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.80 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$441.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$386.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
|
|
IMPLT SCR LCK 2.7MMX16MM EVOS T8 S-T
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$441.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Humana ChoiceCare |
$143.52
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$331.20
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$485.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$138.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$276.00
|
|
