|
IMPLT SCRW BICEP 7X15MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCRW BICEP 7X15MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCRW BICEP 8X15MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCRW BICEP 8X15MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCRW BICEP 9X15MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCRW BICEP 9X15MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCRW HA 7X20MM
|
Facility
|
OP
|
$1,119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.75 |
| Max. Negotiated Rate |
$1,063.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna Commercial |
$951.15
|
| Rate for Payer: First Health Commercial |
$1,007.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,007.10
|
| Rate for Payer: GEHA Commercial |
$895.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,007.10
|
| Rate for Payer: Humana ChoiceCare |
$290.94
|
| Rate for Payer: Multiplan All |
$1,018.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$671.40
|
| Rate for Payer: OMNI Networks Commercial |
$783.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,007.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,063.05
|
| Rate for Payer: Three Rivers Provider Network All |
$839.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$984.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,040.67
|
| Rate for Payer: Zelis Auto |
$447.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$559.50
|
|
|
IMPLT SCRW HA 7X20MM
|
Facility
|
IP
|
$1,119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$1,063.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$895.20
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna Commercial |
$951.15
|
| Rate for Payer: First Health Commercial |
$1,007.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,007.10
|
| Rate for Payer: GEHA Commercial |
$783.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,007.10
|
| Rate for Payer: Multiplan All |
$1,018.29
|
| Rate for Payer: OMNI Networks Commercial |
$783.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,007.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,063.05
|
| Rate for Payer: Three Rivers Provider Network All |
$839.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,040.67
|
| Rate for Payer: Zelis Auto |
$447.60
|
|
|
IMPLT SCRW LCK CORT 3.5X20MM
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.60 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$875.20
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$765.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
|
|
IMPLT SCRW LCK CORT 3.5X20MM
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.50 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$875.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Humana ChoiceCare |
$284.44
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$656.40
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$962.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$547.00
|
|
|
IMPLT SCRW LCK CORT 3.5X24MM
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.60 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$875.20
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$765.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
|
|
IMPLT SCRW LCK CORT 3.5X24MM
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.50 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$875.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Humana ChoiceCare |
$284.44
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$656.40
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$962.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$547.00
|
|
|
IMPLT SCRW LCK CORT 3.5X26MM
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.50 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$875.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Humana ChoiceCare |
$284.44
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$656.40
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$962.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$547.00
|
|
|
IMPLT SCRW LCK CORT 3.5X26MM
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.60 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$875.20
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$765.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
|
|
IMPLT SCRW LCK CORT 3.5X28MM
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.50 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$875.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Humana ChoiceCare |
$284.44
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$656.40
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$962.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$547.00
|
|
|
IMPLT SCRW LCK CORT 3.5X28MM
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.60 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$875.20
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$765.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
|
|
IMPLT SCRW LCK CORT 3.5X30MM
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.50 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$875.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Humana ChoiceCare |
$284.44
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$656.40
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$962.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$547.00
|
|
|
IMPLT SCRW LCK CORT 3.5X30MM
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.60 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$875.20
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$765.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
|
|
IMPLT SCRW LCK CORT 3.5X32MM
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.60 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$875.20
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$765.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
|
|
IMPLT SCRW LCK CORT 3.5X32MM
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.50 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$875.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Humana ChoiceCare |
$284.44
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$656.40
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$962.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$547.00
|
|
|
IMPLT SCRW LCK CORT 3.5X34MM
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.50 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$875.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Humana ChoiceCare |
$284.44
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$656.40
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$962.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$547.00
|
|
|
IMPLT SCRW LCK CORT 3.5X34MM
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.60 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$875.20
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$765.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
|
|
IMPLT SCRW LCK CORT 3.5X36MM
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.50 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$875.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Humana ChoiceCare |
$284.44
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$656.40
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$962.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$547.00
|
|
|
IMPLT SCRW LCK CORT 3.5X36MM
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.60 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$875.20
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$765.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
|
|
IMPLT SCRW LCK CORT 3.5X38MM
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.60 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$875.20
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$765.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
|
