|
IMPLT SCREW 2.5 CORTEX LOCKING 24MM
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$446.40
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 24MM
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
|
|
IMPLT SCREW 2.5 CORTICAL 18MM
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$180.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Humana ChoiceCare |
$58.76
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$135.60
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$198.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: Zelis Auto |
$90.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$113.00
|
|
|
IMPLT SCREW 2.5 CORTICAL 18MM
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.80
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$158.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: Zelis Auto |
$90.40
|
|
|
IMPLT SCREW 2.5MM CORTEX LOCK 12MM
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$446.40
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
|
|
IMPLT SCREW 2.5MM CORTEX LOCK 12MM
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
|
|
IMPLT SCREW 2.5 MM X22MM
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$548.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Humana ChoiceCare |
$178.10
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$411.00
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$602.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$342.50
|
|
|
IMPLT SCREW 2.5 MM X22MM
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$479.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
|
|
IMPLT SCREW 25MMX6.5MM
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$325.20 |
| Max. Negotiated Rate |
$772.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$650.40
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cigna Commercial |
$691.05
|
| Rate for Payer: First Health Commercial |
$731.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$731.70
|
| Rate for Payer: GEHA Commercial |
$569.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$731.70
|
| Rate for Payer: Multiplan All |
$739.83
|
| Rate for Payer: OMNI Networks Commercial |
$569.10
|
| Rate for Payer: One Health Plan PPO/POS |
$731.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$772.35
|
| Rate for Payer: Three Rivers Provider Network All |
$609.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$756.09
|
| Rate for Payer: Zelis Auto |
$325.20
|
|
|
IMPLT SCREW 25MMX6.5MM
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.25 |
| Max. Negotiated Rate |
$772.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cigna Commercial |
$691.05
|
| Rate for Payer: First Health Commercial |
$731.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$731.70
|
| Rate for Payer: GEHA Commercial |
$650.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$731.70
|
| Rate for Payer: Humana ChoiceCare |
$211.38
|
| Rate for Payer: Multiplan All |
$739.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$487.80
|
| Rate for Payer: OMNI Networks Commercial |
$569.10
|
| Rate for Payer: One Health Plan PPO/POS |
$731.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$772.35
|
| Rate for Payer: Three Rivers Provider Network All |
$609.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$715.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$203.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$756.09
|
| Rate for Payer: Zelis Auto |
$325.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.50
|
|
|
IMPLT SCREW 2.5X10 NON-LOCKING
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$203.20
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
|
|
IMPLT SCREW 2.5X10 NON-LOCKING
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$66.04
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$152.40
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$127.00
|
|
|
IMPLT SCREW 2.5 X 14MM
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$548.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Humana ChoiceCare |
$178.10
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$411.00
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$602.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$342.50
|
|
|
IMPLT SCREW 2.5 X 14MM
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$582.25
|
| Rate for Payer: First Health Commercial |
$616.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$616.50
|
| Rate for Payer: GEHA Commercial |
$479.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$616.50
|
| Rate for Payer: Multiplan All |
$623.35
|
| Rate for Payer: OMNI Networks Commercial |
$479.50
|
| Rate for Payer: One Health Plan PPO/POS |
$616.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$650.75
|
| Rate for Payer: Three Rivers Provider Network All |
$513.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.05
|
| Rate for Payer: Zelis Auto |
$274.00
|
|
|
IMPLT SCREW 2.5X14 NON-LOCKING
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$213.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Humana ChoiceCare |
$69.42
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$160.20
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$234.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$133.50
|
|
|
IMPLT SCREW 2.5X14 NON-LOCKING
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.60
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$186.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
|
|
IMPLT SCREW 2.5X16 NON-LOCKING
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: First Health Commercial |
$193.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$193.50
|
| Rate for Payer: GEHA Commercial |
$172.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$193.50
|
| Rate for Payer: Humana ChoiceCare |
$55.90
|
| Rate for Payer: Multiplan All |
$195.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$129.00
|
| Rate for Payer: OMNI Networks Commercial |
$150.50
|
| Rate for Payer: One Health Plan PPO/POS |
$193.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$204.25
|
| Rate for Payer: Three Rivers Provider Network All |
$161.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$189.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.95
|
| Rate for Payer: Zelis Auto |
$86.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.50
|
|
|
IMPLT SCREW 2.5X16 NON-LOCKING
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: First Health Commercial |
$193.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$193.50
|
| Rate for Payer: GEHA Commercial |
$150.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$193.50
|
| Rate for Payer: Multiplan All |
$195.65
|
| Rate for Payer: OMNI Networks Commercial |
$150.50
|
| Rate for Payer: One Health Plan PPO/POS |
$193.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$204.25
|
| Rate for Payer: Three Rivers Provider Network All |
$161.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.95
|
| Rate for Payer: Zelis Auto |
$86.00
|
|
|
IMPLT SCREW 2.5X22MM NON-LOCKING
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$213.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Humana ChoiceCare |
$69.42
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$160.20
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$234.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$133.50
|
|
|
IMPLT SCREW 2.5X22MM NON-LOCKING
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.60
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$186.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
|
|
IMPLT SCREW 2.5X24 NON-LOCKING
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: First Health Commercial |
$193.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$193.50
|
| Rate for Payer: GEHA Commercial |
$172.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$193.50
|
| Rate for Payer: Humana ChoiceCare |
$55.90
|
| Rate for Payer: Multiplan All |
$195.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$129.00
|
| Rate for Payer: OMNI Networks Commercial |
$150.50
|
| Rate for Payer: One Health Plan PPO/POS |
$193.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$204.25
|
| Rate for Payer: Three Rivers Provider Network All |
$161.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$189.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.95
|
| Rate for Payer: Zelis Auto |
$86.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.50
|
|
|
IMPLT SCREW 2.5X24 NON-LOCKING
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: First Health Commercial |
$193.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$193.50
|
| Rate for Payer: GEHA Commercial |
$150.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$193.50
|
| Rate for Payer: Multiplan All |
$195.65
|
| Rate for Payer: OMNI Networks Commercial |
$150.50
|
| Rate for Payer: One Health Plan PPO/POS |
$193.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$204.25
|
| Rate for Payer: Three Rivers Provider Network All |
$161.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.95
|
| Rate for Payer: Zelis Auto |
$86.00
|
|
|
IMPLT SCREW 2.5X26 NON-LOCKING
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: First Health Commercial |
$193.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$193.50
|
| Rate for Payer: GEHA Commercial |
$172.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$193.50
|
| Rate for Payer: Humana ChoiceCare |
$55.90
|
| Rate for Payer: Multiplan All |
$195.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$129.00
|
| Rate for Payer: OMNI Networks Commercial |
$150.50
|
| Rate for Payer: One Health Plan PPO/POS |
$193.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$204.25
|
| Rate for Payer: Three Rivers Provider Network All |
$161.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$189.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.95
|
| Rate for Payer: Zelis Auto |
$86.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.50
|
|
|
IMPLT SCREW 2.5X26 NON-LOCKING
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: First Health Commercial |
$193.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$193.50
|
| Rate for Payer: GEHA Commercial |
$150.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$193.50
|
| Rate for Payer: Multiplan All |
$195.65
|
| Rate for Payer: OMNI Networks Commercial |
$150.50
|
| Rate for Payer: One Health Plan PPO/POS |
$193.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$204.25
|
| Rate for Payer: Three Rivers Provider Network All |
$161.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.95
|
| Rate for Payer: Zelis Auto |
$86.00
|
|
|
IMPLT SCREW 2.7 CORTEX 20MM
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
|
