|
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
|
|
|
IMPLT SCREW 3.2X22MM
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.50 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$1,121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Humana ChoiceCare |
$364.52
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$841.20
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,233.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$350.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$701.00
|
|
|
IMPLT SCREW 3.2X22MM
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70001829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.80 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,121.60
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$981.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
|
|
IMPLT SCREW 3.2X24MM
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.80 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,385.60
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,212.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
|
|
IMPLT SCREW 3.2X24MM
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.00 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,385.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Humana ChoiceCare |
$450.32
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,039.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,524.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$433.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$866.00
|
|
|
IMPLT SCREW 3.2X30
|
Facility
|
OP
|
$1,732.00
|
|
| Hospital Charge Code |
70001804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.00 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,385.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Humana ChoiceCare |
$450.32
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,039.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,524.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$433.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$866.00
|
|
|
IMPLT SCREW 3.2X30
|
Facility
|
IP
|
$1,732.00
|
|
| Hospital Charge Code |
70001804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.80 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,385.60
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,212.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
|
|
IMPLT SCREW 3.2X34
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
70001803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.80 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,385.60
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,212.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
|
|
IMPLT SCREW 3.2X34
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
70001803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.00 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,385.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Humana ChoiceCare |
$450.32
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,039.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,524.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$433.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$866.00
|
|
|
IMPLT SCREW 3.2X34MM
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.50 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$1,121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Humana ChoiceCare |
$364.52
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$841.20
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,233.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$350.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$701.00
|
|
|
IMPLT SCREW 3.2X34MM
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.80 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,121.60
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$981.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
|
|
IMPLT SCREW 3.5 CANNULATED
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.50 |
| Max. Negotiated Rate |
$1,027.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$919.70
|
| Rate for Payer: First Health Commercial |
$973.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$973.80
|
| Rate for Payer: GEHA Commercial |
$865.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$973.80
|
| Rate for Payer: Humana ChoiceCare |
$281.32
|
| Rate for Payer: Multiplan All |
$984.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$649.20
|
| Rate for Payer: OMNI Networks Commercial |
$757.40
|
| Rate for Payer: One Health Plan PPO/POS |
$973.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,027.90
|
| Rate for Payer: Three Rivers Provider Network All |
$811.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$952.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$270.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,006.26
|
| Rate for Payer: Zelis Auto |
$432.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$541.00
|
|
|
IMPLT SCREW 3.5 CANNULATED
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.80 |
| Max. Negotiated Rate |
$1,027.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$865.60
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$919.70
|
| Rate for Payer: First Health Commercial |
$973.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$973.80
|
| Rate for Payer: GEHA Commercial |
$757.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$973.80
|
| Rate for Payer: Multiplan All |
$984.62
|
| Rate for Payer: OMNI Networks Commercial |
$757.40
|
| Rate for Payer: One Health Plan PPO/POS |
$973.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,027.90
|
| Rate for Payer: Three Rivers Provider Network All |
$811.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,006.26
|
| Rate for Payer: Zelis Auto |
$432.80
|
|
|
IMPLT SCREW 3.5 CANNULATED 14MM
|
Facility
|
OP
|
$1,216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: First Health Commercial |
$1,094.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,094.40
|
| Rate for Payer: GEHA Commercial |
$972.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,094.40
|
| Rate for Payer: Humana ChoiceCare |
$316.16
|
| Rate for Payer: Multiplan All |
$1,106.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$729.60
|
| Rate for Payer: OMNI Networks Commercial |
$851.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,094.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,155.20
|
| Rate for Payer: Three Rivers Provider Network All |
$912.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,070.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,130.88
|
| Rate for Payer: Zelis Auto |
$486.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$608.00
|
|
|
IMPLT SCREW 3.5 CANNULATED 14MM
|
Facility
|
IP
|
$1,216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.40 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$972.80
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: First Health Commercial |
$1,094.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,094.40
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,094.40
|
| Rate for Payer: Multiplan All |
$1,106.56
|
| Rate for Payer: OMNI Networks Commercial |
$851.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,094.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,155.20
|
| Rate for Payer: Three Rivers Provider Network All |
$912.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,130.88
|
| Rate for Payer: Zelis Auto |
$486.40
|
|
|
IMPLT SCREW 3.5 CANNULATED 22MM
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.80 |
| Max. Negotiated Rate |
$1,027.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$865.60
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$919.70
|
| Rate for Payer: First Health Commercial |
$973.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$973.80
|
| Rate for Payer: GEHA Commercial |
$757.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$973.80
|
| Rate for Payer: Multiplan All |
$984.62
|
| Rate for Payer: OMNI Networks Commercial |
$757.40
|
| Rate for Payer: One Health Plan PPO/POS |
$973.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,027.90
|
| Rate for Payer: Three Rivers Provider Network All |
$811.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,006.26
|
| Rate for Payer: Zelis Auto |
$432.80
|
|
|
IMPLT SCREW 3.5 CANNULATED 22MM
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.50 |
| Max. Negotiated Rate |
$1,027.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$919.70
|
| Rate for Payer: First Health Commercial |
$973.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$973.80
|
| Rate for Payer: GEHA Commercial |
$865.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$973.80
|
| Rate for Payer: Humana ChoiceCare |
$281.32
|
| Rate for Payer: Multiplan All |
$984.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$649.20
|
| Rate for Payer: OMNI Networks Commercial |
$757.40
|
| Rate for Payer: One Health Plan PPO/POS |
$973.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,027.90
|
| Rate for Payer: Three Rivers Provider Network All |
$811.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$952.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$270.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,006.26
|
| Rate for Payer: Zelis Auto |
$432.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$541.00
|
|
|
IMPLT SCREW 3.5 CANNULATED 30MM
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.60 |
| Max. Negotiated Rate |
$1,105.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$931.20
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$814.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: Zelis Auto |
$465.60
|
|
|
IMPLT SCREW 3.5 CANNULATED 30MM
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$1,105.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$931.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Humana ChoiceCare |
$302.64
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$698.40
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,024.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$291.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: Zelis Auto |
$465.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$582.00
|
|
|
IMPLT SCREW 3.5 CANNULATED 32X11MM
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$1,105.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$931.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Humana ChoiceCare |
$302.64
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$698.40
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,024.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$291.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: Zelis Auto |
$465.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$582.00
|
|
|
IMPLT SCREW 3.5 CANNULATED 32X11MM
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.60 |
| Max. Negotiated Rate |
$1,105.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$931.20
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$814.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: Zelis Auto |
$465.60
|
|
|
IMPLT SCREW 3.5 CORTEX 24MM
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$164.80
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$175.10
|
| Rate for Payer: First Health Commercial |
$185.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$185.40
|
| Rate for Payer: GEHA Commercial |
$144.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$185.40
|
| Rate for Payer: Multiplan All |
$187.46
|
| Rate for Payer: OMNI Networks Commercial |
$144.20
|
| Rate for Payer: One Health Plan PPO/POS |
$185.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$195.70
|
| Rate for Payer: Three Rivers Provider Network All |
$154.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$191.58
|
| Rate for Payer: Zelis Auto |
$82.40
|
|
|
IMPLT SCREW 3.5 CORTEX 24MM
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.50 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$175.10
|
| Rate for Payer: First Health Commercial |
$185.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$185.40
|
| Rate for Payer: GEHA Commercial |
$164.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$185.40
|
| Rate for Payer: Humana ChoiceCare |
$53.56
|
| Rate for Payer: Multiplan All |
$187.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$123.60
|
| Rate for Payer: OMNI Networks Commercial |
$144.20
|
| Rate for Payer: One Health Plan PPO/POS |
$185.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$195.70
|
| Rate for Payer: Three Rivers Provider Network All |
$154.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$181.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$191.58
|
| Rate for Payer: Zelis Auto |
$82.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$103.00
|
|
|
IMPLT SCREW 3.5 CORTEX LOCKING 10MM
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.60
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$316.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
|
|
IMPLT SCREW 3.5 CORTEX LOCKING 10MM
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$361.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Humana ChoiceCare |
$117.52
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$271.20
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$397.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$113.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.00
|
|
