|
IMPLT SCREW 1/2 THREAD 42MM
|
Facility
|
IP
|
$987.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.80 |
| Max. Negotiated Rate |
$937.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$789.60
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cigna Commercial |
$838.95
|
| Rate for Payer: First Health Commercial |
$888.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$888.30
|
| Rate for Payer: GEHA Commercial |
$690.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$888.30
|
| Rate for Payer: Multiplan All |
$898.17
|
| Rate for Payer: OMNI Networks Commercial |
$690.90
|
| Rate for Payer: One Health Plan PPO/POS |
$888.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$937.65
|
| Rate for Payer: Three Rivers Provider Network All |
$740.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$917.91
|
| Rate for Payer: Zelis Auto |
$394.80
|
|
|
IMPLT SCREW 1.2X12MM
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$351.20
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cigna Commercial |
$373.15
|
| Rate for Payer: First Health Commercial |
$395.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$395.10
|
| Rate for Payer: GEHA Commercial |
$307.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$395.10
|
| Rate for Payer: Multiplan All |
$399.49
|
| Rate for Payer: OMNI Networks Commercial |
$307.30
|
| Rate for Payer: One Health Plan PPO/POS |
$395.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$417.05
|
| Rate for Payer: Three Rivers Provider Network All |
$329.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$408.27
|
| Rate for Payer: Zelis Auto |
$175.60
|
|
|
IMPLT SCREW 1.2X12MM
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.75 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$263.40
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cigna Commercial |
$373.15
|
| Rate for Payer: First Health Commercial |
$395.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$395.10
|
| Rate for Payer: GEHA Commercial |
$351.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$395.10
|
| Rate for Payer: Humana ChoiceCare |
$114.14
|
| Rate for Payer: Multiplan All |
$399.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$263.40
|
| Rate for Payer: OMNI Networks Commercial |
$307.30
|
| Rate for Payer: One Health Plan PPO/POS |
$395.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$417.05
|
| Rate for Payer: Three Rivers Provider Network All |
$329.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$386.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$109.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$408.27
|
| Rate for Payer: Zelis Auto |
$175.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$219.50
|
|
|
IMPLT SCREW 1.2X14MM
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$351.20
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cigna Commercial |
$373.15
|
| Rate for Payer: First Health Commercial |
$395.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$395.10
|
| Rate for Payer: GEHA Commercial |
$307.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$395.10
|
| Rate for Payer: Multiplan All |
$399.49
|
| Rate for Payer: OMNI Networks Commercial |
$307.30
|
| Rate for Payer: One Health Plan PPO/POS |
$395.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$417.05
|
| Rate for Payer: Three Rivers Provider Network All |
$329.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$408.27
|
| Rate for Payer: Zelis Auto |
$175.60
|
|
|
IMPLT SCREW 1.2X14MM
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.75 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$263.40
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cigna Commercial |
$373.15
|
| Rate for Payer: First Health Commercial |
$395.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$395.10
|
| Rate for Payer: GEHA Commercial |
$351.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$395.10
|
| Rate for Payer: Humana ChoiceCare |
$114.14
|
| Rate for Payer: Multiplan All |
$399.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$263.40
|
| Rate for Payer: OMNI Networks Commercial |
$307.30
|
| Rate for Payer: One Health Plan PPO/POS |
$395.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$417.05
|
| Rate for Payer: Three Rivers Provider Network All |
$329.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$386.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$109.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$408.27
|
| Rate for Payer: Zelis Auto |
$175.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$219.50
|
|
|
IMPLT SCREW 1.2X18MM
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.50 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$491.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Humana ChoiceCare |
$159.64
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$368.40
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$540.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$153.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$307.00
|
|
|
IMPLT SCREW 1.2X18MM
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$491.20
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$429.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
|
|
IMPLT SCREW 1.2X20MM
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.50 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$491.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Humana ChoiceCare |
$159.64
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$368.40
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$540.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$153.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$307.00
|
|
|
IMPLT SCREW 1.2X20MM
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$491.20
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$429.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
|
|
IMPLT SCREW 1.2X7MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW 1.2X7MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW 13MM X 20MM
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.25 |
| Max. Negotiated Rate |
$1,285.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$1,150.05
|
| Rate for Payer: First Health Commercial |
$1,217.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,217.70
|
| Rate for Payer: GEHA Commercial |
$1,082.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,217.70
|
| Rate for Payer: Humana ChoiceCare |
$351.78
|
| Rate for Payer: Multiplan All |
$1,231.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$811.80
|
| Rate for Payer: OMNI Networks Commercial |
$947.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,217.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,285.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,190.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$338.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,258.29
|
| Rate for Payer: Zelis Auto |
$541.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$676.50
|
|
|
IMPLT SCREW 13MM X 20MM
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,285.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,082.40
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$1,150.05
|
| Rate for Payer: First Health Commercial |
$1,217.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,217.70
|
| Rate for Payer: GEHA Commercial |
$947.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,217.70
|
| Rate for Payer: Multiplan All |
$1,231.23
|
| Rate for Payer: OMNI Networks Commercial |
$947.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,217.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,285.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,258.29
|
| Rate for Payer: Zelis Auto |
$541.20
|
|
|
IMPLT SCREW 14MM LOCKING
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$385.60 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$771.20
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$674.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: Zelis Auto |
$385.60
|
|
|
IMPLT SCREW 14MM LOCKING
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.00 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$771.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Humana ChoiceCare |
$250.64
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$578.40
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$241.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$482.00
|
|
|
IMPLT SCREW 1.5X12MM
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.80 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$513.60
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cigna Commercial |
$545.70
|
| Rate for Payer: First Health Commercial |
$577.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$577.80
|
| Rate for Payer: GEHA Commercial |
$449.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$577.80
|
| Rate for Payer: Multiplan All |
$584.22
|
| Rate for Payer: OMNI Networks Commercial |
$449.40
|
| Rate for Payer: One Health Plan PPO/POS |
$577.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$609.90
|
| Rate for Payer: Three Rivers Provider Network All |
$481.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$597.06
|
| Rate for Payer: Zelis Auto |
$256.80
|
|
|
IMPLT SCREW 1.5X12MM
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.50 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cigna Commercial |
$545.70
|
| Rate for Payer: First Health Commercial |
$577.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$577.80
|
| Rate for Payer: GEHA Commercial |
$513.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$577.80
|
| Rate for Payer: Humana ChoiceCare |
$166.92
|
| Rate for Payer: Multiplan All |
$584.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$385.20
|
| Rate for Payer: OMNI Networks Commercial |
$449.40
|
| Rate for Payer: One Health Plan PPO/POS |
$577.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$609.90
|
| Rate for Payer: Three Rivers Provider Network All |
$481.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$564.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$160.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$597.06
|
| Rate for Payer: Zelis Auto |
$256.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$321.00
|
|
|
IMPLT SCREW 1.5X9MM
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$260.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| Rate for Payer: Humana ChoiceCare |
$84.50
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$195.00
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$286.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: Zelis Auto |
$130.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.50
|
|
|
IMPLT SCREW 1.5X9MM
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$260.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$227.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: Zelis Auto |
$130.00
|
|
|
IMPLT SCREW 16.0MM ACUTRAK BONE
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.00 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$726.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Humana ChoiceCare |
$236.08
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.80
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$799.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$227.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.00
|
|
|
IMPLT SCREW 16.0MM ACUTRAK BONE
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$363.20 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$726.40
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$635.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
|
|
IMPLT SCREW 16MM LOCKING
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.00 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$771.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Humana ChoiceCare |
$250.64
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$578.40
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$241.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$482.00
|
|
|
IMPLT SCREW 16MM LOCKING
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.60 |
| Max. Negotiated Rate |
$1,224.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,031.20
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,095.65
|
| Rate for Payer: First Health Commercial |
$1,160.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.10
|
| Rate for Payer: GEHA Commercial |
$902.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.10
|
| Rate for Payer: Multiplan All |
$1,172.99
|
| Rate for Payer: OMNI Networks Commercial |
$902.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.55
|
| Rate for Payer: Three Rivers Provider Network All |
$966.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.77
|
| Rate for Payer: Zelis Auto |
$515.60
|
|
|
IMPLT SCREW 16MM LOCKING
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$385.60 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$771.20
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$674.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: Zelis Auto |
$385.60
|
|
|
IMPLT SCREW 16MM LOCKING
|
Facility
|
OP
|
$1,289.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.25 |
| Max. Negotiated Rate |
$1,224.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,095.65
|
| Rate for Payer: First Health Commercial |
$1,160.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.10
|
| Rate for Payer: GEHA Commercial |
$1,031.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.10
|
| Rate for Payer: Humana ChoiceCare |
$335.14
|
| Rate for Payer: Multiplan All |
$1,172.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$773.40
|
| Rate for Payer: OMNI Networks Commercial |
$902.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.55
|
| Rate for Payer: Three Rivers Provider Network All |
$966.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,134.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$322.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.77
|
| Rate for Payer: Zelis Auto |
$515.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$644.50
|
|
