|
IMPLT PIN BONE 4X170MM
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$778.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$655.20
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cigna Commercial |
$696.15
|
| Rate for Payer: First Health Commercial |
$737.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$737.10
|
| Rate for Payer: GEHA Commercial |
$573.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$737.10
|
| Rate for Payer: Multiplan All |
$745.29
|
| Rate for Payer: OMNI Networks Commercial |
$573.30
|
| Rate for Payer: One Health Plan PPO/POS |
$737.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$778.05
|
| Rate for Payer: Three Rivers Provider Network All |
$614.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$761.67
|
| Rate for Payer: Zelis Auto |
$327.60
|
|
|
IMPLT PIN BONE 4X170MM
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$778.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cigna Commercial |
$696.15
|
| Rate for Payer: First Health Commercial |
$737.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$737.10
|
| Rate for Payer: GEHA Commercial |
$655.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$737.10
|
| Rate for Payer: Humana ChoiceCare |
$212.94
|
| Rate for Payer: Multiplan All |
$745.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$491.40
|
| Rate for Payer: OMNI Networks Commercial |
$573.30
|
| Rate for Payer: One Health Plan PPO/POS |
$737.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$778.05
|
| Rate for Payer: Three Rivers Provider Network All |
$614.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$720.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$204.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$761.67
|
| Rate for Payer: Zelis Auto |
$327.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$409.50
|
|
|
IMPLT PIN DRILL GUIDE 2.7X14MM
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.50 |
| Max. Negotiated Rate |
$1,092.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$977.50
|
| Rate for Payer: First Health Commercial |
$1,035.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,035.00
|
| Rate for Payer: GEHA Commercial |
$920.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,035.00
|
| Rate for Payer: Humana ChoiceCare |
$299.00
|
| Rate for Payer: Multiplan All |
$1,046.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$690.00
|
| Rate for Payer: OMNI Networks Commercial |
$805.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,035.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,092.50
|
| Rate for Payer: Three Rivers Provider Network All |
$862.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,012.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$287.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,069.50
|
| Rate for Payer: Zelis Auto |
$460.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$575.00
|
|
|
IMPLT PIN DRILL GUIDE 2.7X14MM
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,092.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$920.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$977.50
|
| Rate for Payer: First Health Commercial |
$1,035.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,035.00
|
| Rate for Payer: GEHA Commercial |
$805.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,035.00
|
| Rate for Payer: Multiplan All |
$1,046.50
|
| Rate for Payer: OMNI Networks Commercial |
$805.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,035.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,092.50
|
| Rate for Payer: Three Rivers Provider Network All |
$862.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,069.50
|
| Rate for Payer: Zelis Auto |
$460.00
|
|
|
IMPLT PIN DRILL GUIDE 2.7X40MM
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$888.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$748.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$654.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: Zelis Auto |
$374.00
|
|
|
IMPLT PIN DRILL GUIDE 2.7X40MM
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$888.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$748.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| Rate for Payer: Humana ChoiceCare |
$243.10
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$561.00
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$822.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$233.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: Zelis Auto |
$374.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$467.50
|
|
|
IMPLT PIN FIXATION 0125X3IN.
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.25 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$850.85
|
| Rate for Payer: First Health Commercial |
$900.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$900.90
|
| Rate for Payer: GEHA Commercial |
$800.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$900.90
|
| Rate for Payer: Humana ChoiceCare |
$260.26
|
| Rate for Payer: Multiplan All |
$910.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$700.70
|
| Rate for Payer: One Health Plan PPO/POS |
$900.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$950.95
|
| Rate for Payer: Three Rivers Provider Network All |
$750.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$880.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$250.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$930.93
|
| Rate for Payer: Zelis Auto |
$400.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$500.50
|
|
|
IMPLT PIN FIXATION 0125X3IN.
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$800.80
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$850.85
|
| Rate for Payer: First Health Commercial |
$900.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$900.90
|
| Rate for Payer: GEHA Commercial |
$700.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$900.90
|
| Rate for Payer: Multiplan All |
$910.91
|
| Rate for Payer: OMNI Networks Commercial |
$700.70
|
| Rate for Payer: One Health Plan PPO/POS |
$900.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$950.95
|
| Rate for Payer: Three Rivers Provider Network All |
$750.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$930.93
|
| Rate for Payer: Zelis Auto |
$400.40
|
|
|
IMPLT PIN FIXATION 2.0 14MM
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007020
|
|
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 PIN FIXATION 2.0 14MM
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007020
|
|
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 PIN FLUTED
|
Facility
|
IP
|
$1,033.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.20 |
| Max. Negotiated Rate |
$981.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$826.40
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cigna Commercial |
$878.05
|
| Rate for Payer: First Health Commercial |
$929.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$929.70
|
| Rate for Payer: GEHA Commercial |
$723.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$929.70
|
| Rate for Payer: Multiplan All |
$940.03
|
| Rate for Payer: OMNI Networks Commercial |
$723.10
|
| Rate for Payer: One Health Plan PPO/POS |
$929.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$981.35
|
| Rate for Payer: Three Rivers Provider Network All |
$774.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$960.69
|
| Rate for Payer: Zelis Auto |
$413.20
|
|
|
IMPLT PIN FLUTED
|
Facility
|
OP
|
$1,033.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.25 |
| Max. Negotiated Rate |
$981.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$619.80
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cigna Commercial |
$878.05
|
| Rate for Payer: First Health Commercial |
$929.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$929.70
|
| Rate for Payer: GEHA Commercial |
$826.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$929.70
|
| Rate for Payer: Humana ChoiceCare |
$268.58
|
| Rate for Payer: Multiplan All |
$940.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$619.80
|
| Rate for Payer: OMNI Networks Commercial |
$723.10
|
| Rate for Payer: One Health Plan PPO/POS |
$929.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$981.35
|
| Rate for Payer: Three Rivers Provider Network All |
$774.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$909.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$258.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$960.69
|
| Rate for Payer: Zelis Auto |
$413.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$516.50
|
|
|
IMPLT PIN FLUTED 3/4
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.75 |
| Max. Negotiated Rate |
$1,040.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$930.75
|
| Rate for Payer: First Health Commercial |
$985.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$985.50
|
| Rate for Payer: GEHA Commercial |
$876.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$985.50
|
| Rate for Payer: Humana ChoiceCare |
$284.70
|
| Rate for Payer: Multiplan All |
$996.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$657.00
|
| Rate for Payer: OMNI Networks Commercial |
$766.50
|
| Rate for Payer: One Health Plan PPO/POS |
$985.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,040.25
|
| Rate for Payer: Three Rivers Provider Network All |
$821.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$963.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,018.35
|
| Rate for Payer: Zelis Auto |
$438.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$547.50
|
|
|
IMPLT PIN FLUTED 3/4
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.00 |
| Max. Negotiated Rate |
$1,040.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$876.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$930.75
|
| Rate for Payer: First Health Commercial |
$985.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$985.50
|
| Rate for Payer: GEHA Commercial |
$766.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$985.50
|
| Rate for Payer: Multiplan All |
$996.45
|
| Rate for Payer: OMNI Networks Commercial |
$766.50
|
| Rate for Payer: One Health Plan PPO/POS |
$985.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,040.25
|
| Rate for Payer: Three Rivers Provider Network All |
$821.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,018.35
|
| Rate for Payer: Zelis Auto |
$438.00
|
|
|
IMPLT PIN FLUTED HEADLESS 2.5 INCH
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,453.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$1,300.50
|
| Rate for Payer: First Health Commercial |
$1,377.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,377.00
|
| Rate for Payer: GEHA Commercial |
$1,224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,377.00
|
| Rate for Payer: Humana ChoiceCare |
$397.80
|
| Rate for Payer: Multiplan All |
$1,392.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$918.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,071.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,377.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,453.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,147.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,346.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$382.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,422.90
|
| Rate for Payer: Zelis Auto |
$612.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$765.00
|
|
|
IMPLT PIN FLUTED HEADLESS 2.5 INCH
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$1,453.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,224.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$1,300.50
|
| Rate for Payer: First Health Commercial |
$1,377.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,377.00
|
| Rate for Payer: GEHA Commercial |
$1,071.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,377.00
|
| Rate for Payer: Multiplan All |
$1,392.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,071.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,377.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,453.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,147.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,422.90
|
| Rate for Payer: Zelis Auto |
$612.00
|
|
|
IMPLT PIN FLUTED HEADLESS 3 INCH
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Humana ChoiceCare |
$276.64
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$638.40
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$936.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$532.00
|
|
|
IMPLT PIN FLUTED HEADLESS 3 INCH
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.60 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$851.20
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$744.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
|
|
IMPLT PIN FX SELF DRL SLF TAP AO FIT PLT
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$315.75 |
| Max. Negotiated Rate |
$1,199.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$757.80
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cigna Commercial |
$1,073.55
|
| Rate for Payer: First Health Commercial |
$1,136.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,136.70
|
| Rate for Payer: GEHA Commercial |
$1,010.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,136.70
|
| Rate for Payer: Humana ChoiceCare |
$328.38
|
| Rate for Payer: Multiplan All |
$1,149.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$757.80
|
| Rate for Payer: OMNI Networks Commercial |
$884.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,136.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,199.85
|
| Rate for Payer: Three Rivers Provider Network All |
$947.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,111.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$315.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,174.59
|
| Rate for Payer: Zelis Auto |
$505.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$631.50
|
|
|
IMPLT PIN FX SELF DRL SLF TAP AO FIT PLT
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.20 |
| Max. Negotiated Rate |
$1,199.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,010.40
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cigna Commercial |
$1,073.55
|
| Rate for Payer: First Health Commercial |
$1,136.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,136.70
|
| Rate for Payer: GEHA Commercial |
$884.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,136.70
|
| Rate for Payer: Multiplan All |
$1,149.33
|
| Rate for Payer: OMNI Networks Commercial |
$884.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,136.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,199.85
|
| Rate for Payer: Three Rivers Provider Network All |
$947.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,174.59
|
| Rate for Payer: Zelis Auto |
$505.20
|
|
|
IMPLT PIN GUIDE 2.4MM
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.25 |
| Max. Negotiated Rate |
$399.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$357.85
|
| Rate for Payer: First Health Commercial |
$378.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.90
|
| Rate for Payer: GEHA Commercial |
$336.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.90
|
| Rate for Payer: Humana ChoiceCare |
$109.46
|
| Rate for Payer: Multiplan All |
$383.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.60
|
| Rate for Payer: OMNI Networks Commercial |
$294.70
|
| Rate for Payer: One Health Plan PPO/POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.95
|
| Rate for Payer: Three Rivers Provider Network All |
$315.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$370.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$105.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$391.53
|
| Rate for Payer: Zelis Auto |
$168.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$210.50
|
|
|
IMPLT PIN GUIDE 2.4MM
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.40 |
| Max. Negotiated Rate |
$399.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$336.80
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$357.85
|
| Rate for Payer: First Health Commercial |
$378.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.90
|
| Rate for Payer: GEHA Commercial |
$294.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.90
|
| Rate for Payer: Multiplan All |
$383.11
|
| Rate for Payer: OMNI Networks Commercial |
$294.70
|
| Rate for Payer: One Health Plan PPO/POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.95
|
| Rate for Payer: Three Rivers Provider Network All |
$315.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$391.53
|
| Rate for Payer: Zelis Auto |
$168.40
|
|
|
IMPLT PIN GUIDE W/SUTURE EYE 2.4MM
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001149
|
|
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 PIN GUIDE W/SUTURE EYE 2.4MM
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001149
|
|
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 PIN HALF SELF-DRILL 04MM 150X30MM
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.20 |
| Max. Negotiated Rate |
$663.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$558.40
|
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Cigna Commercial |
$593.30
|
| Rate for Payer: First Health Commercial |
$628.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$628.20
|
| Rate for Payer: GEHA Commercial |
$488.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$628.20
|
| Rate for Payer: Multiplan All |
$635.18
|
| Rate for Payer: OMNI Networks Commercial |
$488.60
|
| Rate for Payer: One Health Plan PPO/POS |
$628.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$663.10
|
| Rate for Payer: Three Rivers Provider Network All |
$523.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$649.14
|
| Rate for Payer: Zelis Auto |
$279.20
|
|
