|
IMPLT SCREW 2.7 CORTEX 20MM
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| 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 |
$153.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$49.92
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$168.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.00
|
|
|
IMPLT SCREW 2.7 LOCKING 16MM
|
Facility
|
IP
|
$691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$656.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$552.80
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$587.35
|
| Rate for Payer: First Health Commercial |
$621.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.90
|
| Rate for Payer: GEHA Commercial |
$483.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.90
|
| Rate for Payer: Multiplan All |
$628.81
|
| Rate for Payer: OMNI Networks Commercial |
$483.70
|
| Rate for Payer: One Health Plan PPO/POS |
$621.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$656.45
|
| Rate for Payer: Three Rivers Provider Network All |
$518.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$642.63
|
| Rate for Payer: Zelis Auto |
$276.40
|
|
|
IMPLT SCREW 2.7 LOCKING 16MM
|
Facility
|
OP
|
$691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$656.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$587.35
|
| Rate for Payer: First Health Commercial |
$621.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.90
|
| Rate for Payer: GEHA Commercial |
$552.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.90
|
| Rate for Payer: Humana ChoiceCare |
$179.66
|
| Rate for Payer: Multiplan All |
$628.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$414.60
|
| Rate for Payer: OMNI Networks Commercial |
$483.70
|
| Rate for Payer: One Health Plan PPO/POS |
$621.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$656.45
|
| Rate for Payer: Three Rivers Provider Network All |
$518.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$608.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$172.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$642.63
|
| Rate for Payer: Zelis Auto |
$276.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$345.50
|
|
|
IMPLT SCREW 2.7 LOCKING 18MM
|
Facility
|
OP
|
$691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$656.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$587.35
|
| Rate for Payer: First Health Commercial |
$621.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.90
|
| Rate for Payer: GEHA Commercial |
$552.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.90
|
| Rate for Payer: Humana ChoiceCare |
$179.66
|
| Rate for Payer: Multiplan All |
$628.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$414.60
|
| Rate for Payer: OMNI Networks Commercial |
$483.70
|
| Rate for Payer: One Health Plan PPO/POS |
$621.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$656.45
|
| Rate for Payer: Three Rivers Provider Network All |
$518.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$608.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$172.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$642.63
|
| Rate for Payer: Zelis Auto |
$276.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$345.50
|
|
|
IMPLT SCREW 2.7 LOCKING 18MM
|
Facility
|
IP
|
$691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$656.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$552.80
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$587.35
|
| Rate for Payer: First Health Commercial |
$621.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.90
|
| Rate for Payer: GEHA Commercial |
$483.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.90
|
| Rate for Payer: Multiplan All |
$628.81
|
| Rate for Payer: OMNI Networks Commercial |
$483.70
|
| Rate for Payer: One Health Plan PPO/POS |
$621.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$656.45
|
| Rate for Payer: Three Rivers Provider Network All |
$518.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$642.63
|
| Rate for Payer: Zelis Auto |
$276.40
|
|
|
IMPLT SCREW 2.7 LOCKING 20MM
|
Facility
|
IP
|
$691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$656.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$552.80
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$587.35
|
| Rate for Payer: First Health Commercial |
$621.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.90
|
| Rate for Payer: GEHA Commercial |
$483.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.90
|
| Rate for Payer: Multiplan All |
$628.81
|
| Rate for Payer: OMNI Networks Commercial |
$483.70
|
| Rate for Payer: One Health Plan PPO/POS |
$621.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$656.45
|
| Rate for Payer: Three Rivers Provider Network All |
$518.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$642.63
|
| Rate for Payer: Zelis Auto |
$276.40
|
|
|
IMPLT SCREW 2.7 LOCKING 20MM
|
Facility
|
OP
|
$691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$656.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$587.35
|
| Rate for Payer: First Health Commercial |
$621.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.90
|
| Rate for Payer: GEHA Commercial |
$552.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.90
|
| Rate for Payer: Humana ChoiceCare |
$179.66
|
| Rate for Payer: Multiplan All |
$628.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$414.60
|
| Rate for Payer: OMNI Networks Commercial |
$483.70
|
| Rate for Payer: One Health Plan PPO/POS |
$621.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$656.45
|
| Rate for Payer: Three Rivers Provider Network All |
$518.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$608.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$172.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$642.63
|
| Rate for Payer: Zelis Auto |
$276.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$345.50
|
|
|
IMPLT SCREW 2.7 LOCKING 22MM
|
Facility
|
OP
|
$691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$656.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$587.35
|
| Rate for Payer: First Health Commercial |
$621.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.90
|
| Rate for Payer: GEHA Commercial |
$552.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.90
|
| Rate for Payer: Humana ChoiceCare |
$179.66
|
| Rate for Payer: Multiplan All |
$628.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$414.60
|
| Rate for Payer: OMNI Networks Commercial |
$483.70
|
| Rate for Payer: One Health Plan PPO/POS |
$621.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$656.45
|
| Rate for Payer: Three Rivers Provider Network All |
$518.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$608.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$172.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$642.63
|
| Rate for Payer: Zelis Auto |
$276.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$345.50
|
|
|
IMPLT SCREW 2.7 LOCKING 22MM
|
Facility
|
IP
|
$691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$656.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$552.80
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$587.35
|
| Rate for Payer: First Health Commercial |
$621.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.90
|
| Rate for Payer: GEHA Commercial |
$483.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.90
|
| Rate for Payer: Multiplan All |
$628.81
|
| Rate for Payer: OMNI Networks Commercial |
$483.70
|
| Rate for Payer: One Health Plan PPO/POS |
$621.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$656.45
|
| Rate for Payer: Three Rivers Provider Network All |
$518.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$642.63
|
| Rate for Payer: Zelis Auto |
$276.40
|
|
|
IMPLT SCREW, 2.7MMX5MMX12MM SYNTHES
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$216.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$189.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| Rate for Payer: Multiplan All |
$245.70
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$256.50
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$251.10
|
| Rate for Payer: Zelis Auto |
$108.00
|
|
|
IMPLT SCREW, 2.7MMX5MMX12MM SYNTHES
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$216.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| Rate for Payer: Humana ChoiceCare |
$70.20
|
| Rate for Payer: Multiplan All |
$245.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$162.00
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$256.50
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$237.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$251.10
|
| Rate for Payer: Zelis Auto |
$108.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$135.00
|
|
|
IMPLT SCREW 2.7X12MM
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$482.40
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$512.55
|
| Rate for Payer: First Health Commercial |
$542.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.70
|
| Rate for Payer: GEHA Commercial |
$422.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.70
|
| Rate for Payer: Multiplan All |
$548.73
|
| Rate for Payer: OMNI Networks Commercial |
$422.10
|
| Rate for Payer: One Health Plan PPO/POS |
$542.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.85
|
| Rate for Payer: Three Rivers Provider Network All |
$452.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.79
|
| Rate for Payer: Zelis Auto |
$241.20
|
|
|
IMPLT SCREW 2.7X12MM
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$512.55
|
| Rate for Payer: First Health Commercial |
$542.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.70
|
| Rate for Payer: GEHA Commercial |
$482.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.70
|
| Rate for Payer: Humana ChoiceCare |
$156.78
|
| Rate for Payer: Multiplan All |
$548.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$361.80
|
| Rate for Payer: OMNI Networks Commercial |
$422.10
|
| Rate for Payer: One Health Plan PPO/POS |
$542.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.85
|
| Rate for Payer: Three Rivers Provider Network All |
$452.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$530.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.79
|
| Rate for Payer: Zelis Auto |
$241.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$301.50
|
|
|
IMPLT SCREW 2.7X12MM LOCKING
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.60 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$619.20
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$541.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
|
|
IMPLT SCREW 2.7X12MM LOCKING
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$619.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Humana ChoiceCare |
$201.24
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$464.40
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$681.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$193.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$387.00
|
|
|
IMPLT SCREW 2.7X14MM
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$438.40
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$465.80
|
| Rate for Payer: First Health Commercial |
$493.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.20
|
| Rate for Payer: GEHA Commercial |
$383.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.20
|
| Rate for Payer: Multiplan All |
$498.68
|
| Rate for Payer: OMNI Networks Commercial |
$383.60
|
| Rate for Payer: One Health Plan PPO/POS |
$493.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$520.60
|
| Rate for Payer: Three Rivers Provider Network All |
$411.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$509.64
|
| Rate for Payer: Zelis Auto |
$219.20
|
|
|
IMPLT SCREW 2.7X14MM
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$465.80
|
| Rate for Payer: First Health Commercial |
$493.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.20
|
| Rate for Payer: GEHA Commercial |
$438.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.20
|
| Rate for Payer: Humana ChoiceCare |
$142.48
|
| Rate for Payer: Multiplan All |
$498.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$328.80
|
| Rate for Payer: OMNI Networks Commercial |
$383.60
|
| Rate for Payer: One Health Plan PPO/POS |
$493.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$520.60
|
| Rate for Payer: Three Rivers Provider Network All |
$411.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$482.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$509.64
|
| Rate for Payer: Zelis Auto |
$219.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$274.00
|
|
|
IMPLT SCREW 2.7X14MM LOCKING
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.60 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$619.20
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$541.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
|
|
IMPLT SCREW 2.7X14MM LOCKING
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$619.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Humana ChoiceCare |
$201.24
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$464.40
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$681.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$193.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$387.00
|
|
|
IMPLT SCREW 2.7X16MM
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$66.30
|
| Rate for Payer: First Health Commercial |
$70.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$70.20
|
| Rate for Payer: GEHA Commercial |
$62.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$70.20
|
| Rate for Payer: Humana ChoiceCare |
$20.28
|
| Rate for Payer: Multiplan All |
$70.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$46.80
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: One Health Plan PPO/POS |
$70.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$74.10
|
| Rate for Payer: Three Rivers Provider Network All |
$58.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$68.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$72.54
|
| Rate for Payer: Zelis Auto |
$31.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$39.00
|
|
|
IMPLT SCREW 2.7X16MM
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$62.40
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$66.30
|
| Rate for Payer: First Health Commercial |
$70.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$70.20
|
| Rate for Payer: GEHA Commercial |
$54.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$70.20
|
| Rate for Payer: Multiplan All |
$70.98
|
| Rate for Payer: OMNI Networks Commercial |
$54.60
|
| Rate for Payer: One Health Plan PPO/POS |
$70.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$74.10
|
| Rate for Payer: Three Rivers Provider Network All |
$58.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$72.54
|
| Rate for Payer: Zelis Auto |
$31.20
|
|
|
IMPLT SCREW 2.7X18MM
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$185.60
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
|
|
IMPLT SCREW 2.7X18MM
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$185.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Humana ChoiceCare |
$60.32
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$139.20
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$204.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$58.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$116.00
|
|
|
IMPLT SCREW 2.7X18MM LOCKING
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$619.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Humana ChoiceCare |
$201.24
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$464.40
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$681.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$193.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$387.00
|
|
|
IMPLT SCREW 2.7X18MM LOCKING
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.60 |
| Max. Negotiated Rate |
$735.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$619.20
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$657.90
|
| Rate for Payer: First Health Commercial |
$696.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$696.60
|
| Rate for Payer: GEHA Commercial |
$541.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$696.60
|
| Rate for Payer: Multiplan All |
$704.34
|
| Rate for Payer: OMNI Networks Commercial |
$541.80
|
| Rate for Payer: One Health Plan PPO/POS |
$696.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$735.30
|
| Rate for Payer: Three Rivers Provider Network All |
$580.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$719.82
|
| Rate for Payer: Zelis Auto |
$309.60
|
|
