|
IMPLT 1.15MM KWIRE
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.75 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$192.95
|
| Rate for Payer: First Health Commercial |
$204.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$181.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Humana ChoiceCare |
$59.02
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$136.20
|
| Rate for Payer: OMNI Networks Commercial |
$158.90
|
| Rate for Payer: One Health Plan PPO/POS |
$204.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$199.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$113.50
|
|
|
IMPLT 1.15MM KWIRE
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$181.60
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$192.95
|
| Rate for Payer: First Health Commercial |
$204.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$158.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: OMNI Networks Commercial |
$158.90
|
| Rate for Payer: One Health Plan PPO/POS |
$204.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: Zelis Auto |
$90.80
|
|
|
IMPLT 1.1 WIRE K ZEBRA
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$129.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Humana ChoiceCare |
$42.12
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.20
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$142.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.00
|
|
|
IMPLT 1.1 WIRE K ZEBRA
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$129.60
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$113.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
|
|
IMPLT 1.20MM KWIRE
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$181.60
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$192.95
|
| Rate for Payer: First Health Commercial |
$204.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$158.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: OMNI Networks Commercial |
$158.90
|
| Rate for Payer: One Health Plan PPO/POS |
$204.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: Zelis Auto |
$90.80
|
|
|
IMPLT 1.20MM KWIRE
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.75 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$192.95
|
| Rate for Payer: First Health Commercial |
$204.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$204.30
|
| Rate for Payer: GEHA Commercial |
$181.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$204.30
|
| Rate for Payer: Humana ChoiceCare |
$59.02
|
| Rate for Payer: Multiplan All |
$206.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$136.20
|
| Rate for Payer: OMNI Networks Commercial |
$158.90
|
| Rate for Payer: One Health Plan PPO/POS |
$204.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$215.65
|
| Rate for Payer: Three Rivers Provider Network All |
$170.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$199.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$211.11
|
| Rate for Payer: Zelis Auto |
$90.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$113.50
|
|
|
IMPLT 2.3 PROFYLE PLATE
|
Facility
|
OP
|
$1,226.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.50 |
| Max. Negotiated Rate |
$1,164.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$735.60
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cigna Commercial |
$1,042.10
|
| Rate for Payer: First Health Commercial |
$1,103.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,103.40
|
| Rate for Payer: GEHA Commercial |
$980.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,103.40
|
| Rate for Payer: Humana ChoiceCare |
$318.76
|
| Rate for Payer: Multiplan All |
$1,115.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$735.60
|
| Rate for Payer: OMNI Networks Commercial |
$858.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,103.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,164.70
|
| Rate for Payer: Three Rivers Provider Network All |
$919.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,078.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$306.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,140.18
|
| Rate for Payer: Zelis Auto |
$490.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.00
|
|
|
IMPLT 2.3 PROFYLE PLATE
|
Facility
|
IP
|
$1,226.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.40 |
| Max. Negotiated Rate |
$1,164.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$980.80
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cigna Commercial |
$1,042.10
|
| Rate for Payer: First Health Commercial |
$1,103.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,103.40
|
| Rate for Payer: GEHA Commercial |
$858.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,103.40
|
| Rate for Payer: Multiplan All |
$1,115.66
|
| Rate for Payer: OMNI Networks Commercial |
$858.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,103.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,164.70
|
| Rate for Payer: Three Rivers Provider Network All |
$919.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,140.18
|
| Rate for Payer: Zelis Auto |
$490.40
|
|
|
IMPLT 2.5X25MM FEMALE SCREW
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.00 |
| Max. Negotiated Rate |
$935.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$788.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$837.25
|
| Rate for Payer: First Health Commercial |
$886.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$886.50
|
| Rate for Payer: GEHA Commercial |
$689.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$886.50
|
| Rate for Payer: Multiplan All |
$896.35
|
| Rate for Payer: OMNI Networks Commercial |
$689.50
|
| Rate for Payer: One Health Plan PPO/POS |
$886.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$935.75
|
| Rate for Payer: Three Rivers Provider Network All |
$738.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$916.05
|
| Rate for Payer: Zelis Auto |
$394.00
|
|
|
IMPLT 2.5X25MM FEMALE SCREW
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.25 |
| Max. Negotiated Rate |
$935.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$837.25
|
| Rate for Payer: First Health Commercial |
$886.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$886.50
|
| Rate for Payer: GEHA Commercial |
$788.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$886.50
|
| Rate for Payer: Humana ChoiceCare |
$256.10
|
| Rate for Payer: Multiplan All |
$896.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$591.00
|
| Rate for Payer: OMNI Networks Commercial |
$689.50
|
| Rate for Payer: One Health Plan PPO/POS |
$886.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$935.75
|
| Rate for Payer: Three Rivers Provider Network All |
$738.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$866.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$916.05
|
| Rate for Payer: Zelis Auto |
$394.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$492.50
|
|
|
IMPLT 3.2 X 32 TWIN FIX COMP SCREW
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.80 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,121.60
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$981.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
|
|
IMPLT 3.2 X 32 TWIN FIX COMP SCREW
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.50 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$1,121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Humana ChoiceCare |
$364.52
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$841.20
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,233.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$350.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$701.00
|
|
|
IMPLT 3.2X75MM TROCAR DRILL PIN
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.50 |
| Max. Negotiated Rate |
$1,814.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,146.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$1,623.50
|
| Rate for Payer: First Health Commercial |
$1,719.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,719.00
|
| Rate for Payer: GEHA Commercial |
$1,528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,719.00
|
| Rate for Payer: Humana ChoiceCare |
$496.60
|
| Rate for Payer: Multiplan All |
$1,738.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,146.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,337.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,719.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,814.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,432.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,680.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$477.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,776.30
|
| Rate for Payer: Zelis Auto |
$764.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$955.00
|
|
|
IMPLT 3.2X75MM TROCAR DRILL PIN
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$764.00 |
| Max. Negotiated Rate |
$1,814.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,528.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$1,623.50
|
| Rate for Payer: First Health Commercial |
$1,719.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,719.00
|
| Rate for Payer: GEHA Commercial |
$1,337.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,719.00
|
| Rate for Payer: Multiplan All |
$1,738.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,337.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,719.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,814.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,432.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,776.30
|
| Rate for Payer: Zelis Auto |
$764.00
|
|
|
IMPLT 3X3CM GRAFIXPL
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,720.00 |
| Max. Negotiated Rate |
$4,085.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,440.00
|
| Rate for Payer: Cash Price |
$2,580.00
|
| Rate for Payer: Cash Price |
$2,580.00
|
| Rate for Payer: Cigna Commercial |
$3,655.00
|
| Rate for Payer: First Health Commercial |
$3,870.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,870.00
|
| Rate for Payer: GEHA Commercial |
$3,010.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,870.00
|
| Rate for Payer: Multiplan All |
$3,913.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,010.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,870.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,085.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,225.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,999.00
|
| Rate for Payer: Zelis Auto |
$1,720.00
|
|
|
IMPLT 3X3CM GRAFIXPL
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.00 |
| Max. Negotiated Rate |
$4,085.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,580.00
|
| Rate for Payer: Cash Price |
$2,580.00
|
| Rate for Payer: Cash Price |
$2,580.00
|
| Rate for Payer: Cigna Commercial |
$3,655.00
|
| Rate for Payer: First Health Commercial |
$3,870.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,870.00
|
| Rate for Payer: GEHA Commercial |
$3,440.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,870.00
|
| Rate for Payer: Humana ChoiceCare |
$1,118.00
|
| Rate for Payer: Multiplan All |
$3,913.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,580.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,010.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,870.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,085.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,225.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,784.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,075.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,999.00
|
| Rate for Payer: Zelis Auto |
$1,720.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,150.00
|
|
|
IMPLT 4.0MM CANCELLOUS SCREW 207.010
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$132.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Humana ChoiceCare |
$42.90
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$99.00
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$82.50
|
|
|
IMPLT 4.0MM CANCELLOUS SCREW 207.010
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$115.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
|
|
IMPLT 4 HOLE PLATE
|
Facility
|
IP
|
$3,681.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.40 |
| Max. Negotiated Rate |
$3,496.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,944.80
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cigna Commercial |
$3,128.85
|
| Rate for Payer: First Health Commercial |
$3,312.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,312.90
|
| Rate for Payer: GEHA Commercial |
$2,576.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,312.90
|
| Rate for Payer: Multiplan All |
$3,349.71
|
| Rate for Payer: OMNI Networks Commercial |
$2,576.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,312.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,496.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,760.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,423.33
|
| Rate for Payer: Zelis Auto |
$1,472.40
|
|
|
IMPLT 4 HOLE PLATE
|
Facility
|
OP
|
$3,681.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.25 |
| Max. Negotiated Rate |
$3,496.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,208.60
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cigna Commercial |
$3,128.85
|
| Rate for Payer: First Health Commercial |
$3,312.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,312.90
|
| Rate for Payer: GEHA Commercial |
$2,944.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,312.90
|
| Rate for Payer: Humana ChoiceCare |
$957.06
|
| Rate for Payer: Multiplan All |
$3,349.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,208.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,576.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,312.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,496.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,760.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,239.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$920.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,423.33
|
| Rate for Payer: Zelis Auto |
$1,472.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,840.50
|
|
|
IMPLT 5 HOLE PLATE
|
Facility
|
IP
|
$9,914.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,965.60 |
| Max. Negotiated Rate |
$9,418.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,931.20
|
| Rate for Payer: Cash Price |
$5,948.40
|
| Rate for Payer: Cash Price |
$5,948.40
|
| Rate for Payer: Cigna Commercial |
$8,426.90
|
| Rate for Payer: First Health Commercial |
$8,922.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,922.60
|
| Rate for Payer: GEHA Commercial |
$6,939.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,922.60
|
| Rate for Payer: Multiplan All |
$9,021.74
|
| Rate for Payer: OMNI Networks Commercial |
$6,939.80
|
| Rate for Payer: One Health Plan PPO/POS |
$8,922.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,418.30
|
| Rate for Payer: Three Rivers Provider Network All |
$7,435.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,220.02
|
| Rate for Payer: Zelis Auto |
$3,965.60
|
|
|
IMPLT 5 HOLE PLATE
|
Facility
|
OP
|
$9,914.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,478.50 |
| Max. Negotiated Rate |
$9,418.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,948.40
|
| Rate for Payer: Cash Price |
$5,948.40
|
| Rate for Payer: Cash Price |
$5,948.40
|
| Rate for Payer: Cigna Commercial |
$8,426.90
|
| Rate for Payer: First Health Commercial |
$8,922.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,922.60
|
| Rate for Payer: GEHA Commercial |
$7,931.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,922.60
|
| Rate for Payer: Humana ChoiceCare |
$2,577.64
|
| Rate for Payer: Multiplan All |
$9,021.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,948.40
|
| Rate for Payer: OMNI Networks Commercial |
$6,939.80
|
| Rate for Payer: One Health Plan PPO/POS |
$8,922.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,418.30
|
| Rate for Payer: Three Rivers Provider Network All |
$7,435.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,724.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,478.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,220.02
|
| Rate for Payer: Zelis Auto |
$3,965.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,957.00
|
|
|
IMPLT 5X5 GRAFIXPL
|
Facility
|
OP
|
$8,267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,066.75 |
| Max. Negotiated Rate |
$7,853.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,960.20
|
| Rate for Payer: Cash Price |
$4,960.20
|
| Rate for Payer: Cash Price |
$4,960.20
|
| Rate for Payer: Cigna Commercial |
$7,026.95
|
| Rate for Payer: First Health Commercial |
$7,440.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,440.30
|
| Rate for Payer: GEHA Commercial |
$6,613.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,440.30
|
| Rate for Payer: Humana ChoiceCare |
$2,149.42
|
| Rate for Payer: Multiplan All |
$7,522.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,960.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,786.90
|
| Rate for Payer: One Health Plan PPO/POS |
$7,440.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,853.65
|
| Rate for Payer: Three Rivers Provider Network All |
$6,200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,274.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,066.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,688.31
|
| Rate for Payer: Zelis Auto |
$3,306.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,133.50
|
|
|
IMPLT 5X5 GRAFIXPL
|
Facility
|
IP
|
$8,267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,306.80 |
| Max. Negotiated Rate |
$7,853.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,613.60
|
| Rate for Payer: Cash Price |
$4,960.20
|
| Rate for Payer: Cash Price |
$4,960.20
|
| Rate for Payer: Cigna Commercial |
$7,026.95
|
| Rate for Payer: First Health Commercial |
$7,440.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,440.30
|
| Rate for Payer: GEHA Commercial |
$5,786.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,440.30
|
| Rate for Payer: Multiplan All |
$7,522.97
|
| Rate for Payer: OMNI Networks Commercial |
$5,786.90
|
| Rate for Payer: One Health Plan PPO/POS |
$7,440.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,853.65
|
| Rate for Payer: Three Rivers Provider Network All |
$6,200.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,688.31
|
| Rate for Payer: Zelis Auto |
$3,306.80
|
|
|
IMPLT ACCORD 115MM TROCHANTRIC GRIP
|
Facility
|
OP
|
$5,381.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,345.25 |
| Max. Negotiated Rate |
$5,111.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,228.60
|
| Rate for Payer: Cash Price |
$3,228.60
|
| Rate for Payer: Cash Price |
$3,228.60
|
| Rate for Payer: Cigna Commercial |
$4,573.85
|
| Rate for Payer: First Health Commercial |
$4,842.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,842.90
|
| Rate for Payer: GEHA Commercial |
$4,304.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,842.90
|
| Rate for Payer: Humana ChoiceCare |
$1,399.06
|
| Rate for Payer: Multiplan All |
$4,896.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,228.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,766.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,842.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,111.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,035.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,735.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,345.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,004.33
|
| Rate for Payer: Zelis Auto |
$2,152.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,690.50
|
|
