|
IMPLT PIN HALF SELF-DRILL 04MM 150X30MM
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$663.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$418.80
|
| 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 |
$558.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$628.20
|
| Rate for Payer: Humana ChoiceCare |
$181.48
|
| Rate for Payer: Multiplan All |
$635.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$418.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$614.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$174.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$649.14
|
| Rate for Payer: Zelis Auto |
$279.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$349.00
|
|
|
IMPLT PIN HALF SELF-DRILL 04MM 150X40MM
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003473
|
|
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
|
|
|
IMPLT PIN HALF SELF-DRILL 04MM 150X40MM
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$663.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$418.80
|
| 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 |
$558.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$628.20
|
| Rate for Payer: Humana ChoiceCare |
$181.48
|
| Rate for Payer: Multiplan All |
$635.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$418.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$614.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$174.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$649.14
|
| Rate for Payer: Zelis Auto |
$279.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$349.00
|
|
|
IMPLT PIN HEADED 1.5MM
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.75 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$546.60
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$728.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Humana ChoiceCare |
$236.86
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$546.60
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$801.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$227.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.50
|
|
|
IMPLT PIN HEADED 1.5MM
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$364.40 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$728.80
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$637.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: Zelis Auto |
$364.40
|
|
|
IMPLT PIN HEADED 1.5MM
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$420.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$367.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
|
|
IMPLT PIN HEADED 1.5MM
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Humana ChoiceCare |
$136.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$315.00
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$462.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$131.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$262.50
|
|
|
IMPLT PIN HEADED 3/4
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000302
|
|
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 HEADED 3/4
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000302
|
|
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 HLF 45MM 1.65MM 12 APX HFMN2
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna Commercial |
$425.85
|
| Rate for Payer: First Health Commercial |
$450.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.90
|
| Rate for Payer: GEHA Commercial |
$400.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.90
|
| Rate for Payer: Humana ChoiceCare |
$130.26
|
| Rate for Payer: Multiplan All |
$455.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$300.60
|
| Rate for Payer: OMNI Networks Commercial |
$350.70
|
| Rate for Payer: One Health Plan PPO/POS |
$450.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.95
|
| Rate for Payer: Three Rivers Provider Network All |
$375.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$440.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.93
|
| Rate for Payer: Zelis Auto |
$200.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$250.50
|
|
|
IMPLT PIN HLF 45MM 1.65MM 12 APX HFMN2
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$400.80
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna Commercial |
$425.85
|
| Rate for Payer: First Health Commercial |
$450.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.90
|
| Rate for Payer: GEHA Commercial |
$350.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.90
|
| Rate for Payer: Multiplan All |
$455.91
|
| Rate for Payer: OMNI Networks Commercial |
$350.70
|
| Rate for Payer: One Health Plan PPO/POS |
$450.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.95
|
| Rate for Payer: Three Rivers Provider Network All |
$375.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.93
|
| Rate for Payer: Zelis Auto |
$200.40
|
|
|
IMPLT PIN KIT REUNITE 1.5X 60MM
|
Facility
|
IP
|
$1,829.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.60 |
| Max. Negotiated Rate |
$1,737.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,463.20
|
| Rate for Payer: Cash Price |
$1,097.40
|
| Rate for Payer: Cash Price |
$1,097.40
|
| Rate for Payer: Cigna Commercial |
$1,554.65
|
| Rate for Payer: First Health Commercial |
$1,646.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,646.10
|
| Rate for Payer: GEHA Commercial |
$1,280.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,646.10
|
| Rate for Payer: Multiplan All |
$1,664.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,280.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,646.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,737.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,371.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,700.97
|
| Rate for Payer: Zelis Auto |
$731.60
|
|
|
IMPLT PIN KIT REUNITE 1.5X 60MM
|
Facility
|
OP
|
$1,829.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.25 |
| Max. Negotiated Rate |
$1,737.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,097.40
|
| Rate for Payer: Cash Price |
$1,097.40
|
| Rate for Payer: Cash Price |
$1,097.40
|
| Rate for Payer: Cigna Commercial |
$1,554.65
|
| Rate for Payer: First Health Commercial |
$1,646.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,646.10
|
| Rate for Payer: GEHA Commercial |
$1,463.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,646.10
|
| Rate for Payer: Humana ChoiceCare |
$475.54
|
| Rate for Payer: Multiplan All |
$1,664.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,097.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,280.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,646.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,737.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,371.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,609.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$457.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,700.97
|
| Rate for Payer: Zelis Auto |
$731.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$914.50
|
|
|
IMPLT PIN PERILOC 2.7X40MM
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.25 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$682.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Humana ChoiceCare |
$221.78
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$511.80
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$750.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$426.50
|
|
|
IMPLT PIN PERILOC 2.7X40MM
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.20 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$682.40
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$597.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: Zelis Auto |
$341.20
|
|
|
IMPLT PIN PF 2.7X25MM
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.25 |
| Max. Negotiated Rate |
$783.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna Commercial |
$701.25
|
| Rate for Payer: First Health Commercial |
$742.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$742.50
|
| Rate for Payer: GEHA Commercial |
$660.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$742.50
|
| Rate for Payer: Humana ChoiceCare |
$214.50
|
| Rate for Payer: Multiplan All |
$750.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$495.00
|
| Rate for Payer: OMNI Networks Commercial |
$577.50
|
| Rate for Payer: One Health Plan PPO/POS |
$742.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$783.75
|
| Rate for Payer: Three Rivers Provider Network All |
$618.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$726.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$767.25
|
| Rate for Payer: Zelis Auto |
$330.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$412.50
|
|
|
IMPLT PIN PF 2.7X25MM
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$783.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$660.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna Commercial |
$701.25
|
| Rate for Payer: First Health Commercial |
$742.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$742.50
|
| Rate for Payer: GEHA Commercial |
$577.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$742.50
|
| Rate for Payer: Multiplan All |
$750.75
|
| Rate for Payer: OMNI Networks Commercial |
$577.50
|
| Rate for Payer: One Health Plan PPO/POS |
$742.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$783.75
|
| Rate for Payer: Three Rivers Provider Network All |
$618.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$767.25
|
| Rate for Payer: Zelis Auto |
$330.00
|
|
|
IMPLT PIN PF 40MM
|
Facility
|
IP
|
$982.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.80 |
| Max. Negotiated Rate |
$932.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.60
|
| Rate for Payer: Cash Price |
$589.20
|
| Rate for Payer: Cash Price |
$589.20
|
| Rate for Payer: Cigna Commercial |
$834.70
|
| Rate for Payer: First Health Commercial |
$883.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$883.80
|
| Rate for Payer: GEHA Commercial |
$687.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$883.80
|
| Rate for Payer: Multiplan All |
$893.62
|
| Rate for Payer: OMNI Networks Commercial |
$687.40
|
| Rate for Payer: One Health Plan PPO/POS |
$883.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$932.90
|
| Rate for Payer: Three Rivers Provider Network All |
$736.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$913.26
|
| Rate for Payer: Zelis Auto |
$392.80
|
|
|
IMPLT PIN PF 40MM
|
Facility
|
OP
|
$982.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.50 |
| Max. Negotiated Rate |
$932.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$589.20
|
| Rate for Payer: Cash Price |
$589.20
|
| Rate for Payer: Cash Price |
$589.20
|
| Rate for Payer: Cigna Commercial |
$834.70
|
| Rate for Payer: First Health Commercial |
$883.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$883.80
|
| Rate for Payer: GEHA Commercial |
$785.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$883.80
|
| Rate for Payer: Humana ChoiceCare |
$255.32
|
| Rate for Payer: Multiplan All |
$893.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$589.20
|
| Rate for Payer: OMNI Networks Commercial |
$687.40
|
| Rate for Payer: One Health Plan PPO/POS |
$883.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$932.90
|
| Rate for Payer: Three Rivers Provider Network All |
$736.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$864.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$245.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$913.26
|
| Rate for Payer: Zelis Auto |
$392.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$491.00
|
|
|
IMPLT PIN STEINMANN 1/8X23CM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT PIN STEINMANN 1/8X23CM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT PIN STEINMANN 1/8X2.5 LONG
|
Facility
|
IP
|
$1,427.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.80 |
| Max. Negotiated Rate |
$1,355.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,141.60
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cigna Commercial |
$1,212.95
|
| Rate for Payer: First Health Commercial |
$1,284.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,284.30
|
| Rate for Payer: GEHA Commercial |
$998.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,284.30
|
| Rate for Payer: Multiplan All |
$1,298.57
|
| Rate for Payer: OMNI Networks Commercial |
$998.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,284.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,355.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,070.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,327.11
|
| Rate for Payer: Zelis Auto |
$570.80
|
|
|
IMPLT PIN STEINMANN 1/8X2.5 LONG
|
Facility
|
OP
|
$1,427.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$356.75 |
| Max. Negotiated Rate |
$1,355.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$856.20
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cigna Commercial |
$1,212.95
|
| Rate for Payer: First Health Commercial |
$1,284.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,284.30
|
| Rate for Payer: GEHA Commercial |
$1,141.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,284.30
|
| Rate for Payer: Humana ChoiceCare |
$371.02
|
| Rate for Payer: Multiplan All |
$1,298.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.20
|
| Rate for Payer: OMNI Networks Commercial |
$998.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,284.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,355.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,070.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,255.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$356.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,327.11
|
| Rate for Payer: Zelis Auto |
$570.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$713.50
|
|
|
IMPLT PIN STEINMANN 3/16
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$332.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$373.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$373.50
|
| Rate for Payer: GEHA Commercial |
$290.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$373.50
|
| Rate for Payer: Multiplan All |
$377.65
|
| Rate for Payer: OMNI Networks Commercial |
$290.50
|
| Rate for Payer: One Health Plan PPO/POS |
$373.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$394.25
|
| Rate for Payer: Three Rivers Provider Network All |
$311.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$385.95
|
| Rate for Payer: Zelis Auto |
$166.00
|
|
|
IMPLT PIN STEINMANN 3/16
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.75 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$373.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$373.50
|
| Rate for Payer: GEHA Commercial |
$332.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$373.50
|
| Rate for Payer: Humana ChoiceCare |
$107.90
|
| Rate for Payer: Multiplan All |
$377.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$249.00
|
| Rate for Payer: OMNI Networks Commercial |
$290.50
|
| Rate for Payer: One Health Plan PPO/POS |
$373.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$394.25
|
| Rate for Payer: Three Rivers Provider Network All |
$311.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$365.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$103.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$385.95
|
| Rate for Payer: Zelis Auto |
$166.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$207.50
|
|
