|
IMPLT SCREW 2.7X20MM
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$312.40 |
| Max. Negotiated Rate |
$741.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$624.80
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cigna Commercial |
$663.85
|
| Rate for Payer: First Health Commercial |
$702.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$702.90
|
| Rate for Payer: GEHA Commercial |
$546.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$702.90
|
| Rate for Payer: Multiplan All |
$710.71
|
| Rate for Payer: OMNI Networks Commercial |
$546.70
|
| Rate for Payer: One Health Plan PPO/POS |
$702.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$741.95
|
| Rate for Payer: Three Rivers Provider Network All |
$585.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$726.33
|
| Rate for Payer: Zelis Auto |
$312.40
|
|
|
IMPLT SCREW 2.7X20MM
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.25 |
| Max. Negotiated Rate |
$741.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$468.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cigna Commercial |
$663.85
|
| Rate for Payer: First Health Commercial |
$702.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$702.90
|
| Rate for Payer: GEHA Commercial |
$624.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$702.90
|
| Rate for Payer: Humana ChoiceCare |
$203.06
|
| Rate for Payer: Multiplan All |
$710.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$468.60
|
| Rate for Payer: OMNI Networks Commercial |
$546.70
|
| Rate for Payer: One Health Plan PPO/POS |
$702.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$741.95
|
| Rate for Payer: Three Rivers Provider Network All |
$585.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$687.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$726.33
|
| Rate for Payer: Zelis Auto |
$312.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$390.50
|
|
|
IMPLT SCREW 2.7X20MM LOCKING
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000675
|
|
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 2.7X20MM LOCKING
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000675
|
|
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 28MM FRAG SMALL
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$704.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Humana ChoiceCare |
$229.06
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$528.60
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$775.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$440.50
|
|
|
IMPLT SCREW 28MM FRAG SMALL
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$704.80
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$616.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
|
|
IMPLT SCREW 2 x 18MM
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003502
|
|
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 2 x 18MM
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003502
|
|
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 3.0 LAPIPLASTY
|
Facility
|
IP
|
$2,829.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,131.60 |
| Max. Negotiated Rate |
$2,687.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,263.20
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cigna Commercial |
$2,404.65
|
| Rate for Payer: First Health Commercial |
$2,546.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,546.10
|
| Rate for Payer: GEHA Commercial |
$1,980.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,546.10
|
| Rate for Payer: Multiplan All |
$2,574.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,980.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,546.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,687.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,121.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,630.97
|
| Rate for Payer: Zelis Auto |
$1,131.60
|
|
|
IMPLT SCREW 3.0 LAPIPLASTY
|
Facility
|
OP
|
$2,829.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.25 |
| Max. Negotiated Rate |
$2,687.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cigna Commercial |
$2,404.65
|
| Rate for Payer: First Health Commercial |
$2,546.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,546.10
|
| Rate for Payer: GEHA Commercial |
$2,263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,546.10
|
| Rate for Payer: Humana ChoiceCare |
$735.54
|
| Rate for Payer: Multiplan All |
$2,574.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,697.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,980.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,546.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,687.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,121.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,489.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$707.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,630.97
|
| Rate for Payer: Zelis Auto |
$1,131.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,414.50
|
|
|
IMPLT SCREW 30MM FRAG SMALL
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$704.80
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$616.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
|
|
IMPLT SCREW 30MM FRAG SMALL
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$704.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Humana ChoiceCare |
$229.06
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$528.60
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$775.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$440.50
|
|
|
IMPLT SCREW 30MMX6.5MM
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000697
|
|
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 30MMX6.5MM
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000697
|
|
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 3.0X13MM SCREW
|
Facility
|
OP
|
$849.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$212.44 |
| Max. Negotiated Rate |
$807.27 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$509.86
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cigna Commercial |
$722.30
|
| Rate for Payer: First Health Commercial |
$764.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$764.78
|
| Rate for Payer: GEHA Commercial |
$679.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$764.78
|
| Rate for Payer: Humana ChoiceCare |
$220.94
|
| Rate for Payer: Multiplan All |
$773.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$509.86
|
| Rate for Payer: OMNI Networks Commercial |
$594.83
|
| Rate for Payer: One Health Plan PPO/POS |
$764.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$807.27
|
| Rate for Payer: Three Rivers Provider Network All |
$637.32
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$747.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$212.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$790.28
|
| Rate for Payer: Zelis Auto |
$339.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$424.88
|
|
|
IMPLT SCREW 3.0X13MM SCREW
|
Facility
|
IP
|
$849.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.90 |
| Max. Negotiated Rate |
$807.27 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$679.81
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cigna Commercial |
$722.30
|
| Rate for Payer: First Health Commercial |
$764.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$764.78
|
| Rate for Payer: GEHA Commercial |
$594.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$764.78
|
| Rate for Payer: Multiplan All |
$773.28
|
| Rate for Payer: OMNI Networks Commercial |
$594.83
|
| Rate for Payer: One Health Plan PPO/POS |
$764.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$807.27
|
| Rate for Payer: Three Rivers Provider Network All |
$637.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$790.28
|
| Rate for Payer: Zelis Auto |
$339.90
|
|
|
IMPLT SCREW 3.0X16MM SCREW
|
Facility
|
IP
|
$849.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.90 |
| Max. Negotiated Rate |
$807.27 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$679.81
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cigna Commercial |
$722.30
|
| Rate for Payer: First Health Commercial |
$764.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$764.78
|
| Rate for Payer: GEHA Commercial |
$594.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$764.78
|
| Rate for Payer: Multiplan All |
$773.28
|
| Rate for Payer: OMNI Networks Commercial |
$594.83
|
| Rate for Payer: One Health Plan PPO/POS |
$764.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$807.27
|
| Rate for Payer: Three Rivers Provider Network All |
$637.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$790.28
|
| Rate for Payer: Zelis Auto |
$339.90
|
|
|
IMPLT SCREW 3.0X16MM SCREW
|
Facility
|
OP
|
$849.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$212.44 |
| Max. Negotiated Rate |
$807.27 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$509.86
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cigna Commercial |
$722.30
|
| Rate for Payer: First Health Commercial |
$764.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$764.78
|
| Rate for Payer: GEHA Commercial |
$679.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$764.78
|
| Rate for Payer: Humana ChoiceCare |
$220.94
|
| Rate for Payer: Multiplan All |
$773.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$509.86
|
| Rate for Payer: OMNI Networks Commercial |
$594.83
|
| Rate for Payer: One Health Plan PPO/POS |
$764.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$807.27
|
| Rate for Payer: Three Rivers Provider Network All |
$637.32
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$747.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$212.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$790.28
|
| Rate for Payer: Zelis Auto |
$339.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$424.88
|
|
|
IMPLT SCREW 3.0X17MM SCREW
|
Facility
|
IP
|
$849.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.90 |
| Max. Negotiated Rate |
$807.27 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$679.81
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cigna Commercial |
$722.30
|
| Rate for Payer: First Health Commercial |
$764.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$764.78
|
| Rate for Payer: GEHA Commercial |
$594.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$764.78
|
| Rate for Payer: Multiplan All |
$773.28
|
| Rate for Payer: OMNI Networks Commercial |
$594.83
|
| Rate for Payer: One Health Plan PPO/POS |
$764.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$807.27
|
| Rate for Payer: Three Rivers Provider Network All |
$637.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$790.28
|
| Rate for Payer: Zelis Auto |
$339.90
|
|
|
IMPLT SCREW 3.0X17MM SCREW
|
Facility
|
OP
|
$849.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$212.44 |
| Max. Negotiated Rate |
$807.27 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$509.86
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cigna Commercial |
$722.30
|
| Rate for Payer: First Health Commercial |
$764.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$764.78
|
| Rate for Payer: GEHA Commercial |
$679.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$764.78
|
| Rate for Payer: Humana ChoiceCare |
$220.94
|
| Rate for Payer: Multiplan All |
$773.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$509.86
|
| Rate for Payer: OMNI Networks Commercial |
$594.83
|
| Rate for Payer: One Health Plan PPO/POS |
$764.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$807.27
|
| Rate for Payer: Three Rivers Provider Network All |
$637.32
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$747.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$212.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$790.28
|
| Rate for Payer: Zelis Auto |
$339.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$424.88
|
|
|
IMPLT SCREW 3.0 X 24MM
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001262
|
|
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 3.0 X 24MM
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001262
|
|
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 3.0 X 28 MM
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001263
|
|
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 3.0 X 28 MM
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001263
|
|
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 3.0X40MM SCREW
|
Facility
|
IP
|
$849.76
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.90 |
| Max. Negotiated Rate |
$807.27 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$679.81
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cash Price |
$509.86
|
| Rate for Payer: Cigna Commercial |
$722.30
|
| Rate for Payer: First Health Commercial |
$764.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$764.78
|
| Rate for Payer: GEHA Commercial |
$594.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$764.78
|
| Rate for Payer: Multiplan All |
$773.28
|
| Rate for Payer: OMNI Networks Commercial |
$594.83
|
| Rate for Payer: One Health Plan PPO/POS |
$764.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$807.27
|
| Rate for Payer: Three Rivers Provider Network All |
$637.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$790.28
|
| Rate for Payer: Zelis Auto |
$339.90
|
|
