|
IMPLT SCREW 3.5X14MM
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$191.25
|
| Rate for Payer: First Health Commercial |
$202.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$202.50
|
| Rate for Payer: GEHA Commercial |
$157.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$202.50
|
| Rate for Payer: Multiplan All |
$204.75
|
| Rate for Payer: OMNI Networks Commercial |
$157.50
|
| Rate for Payer: One Health Plan PPO/POS |
$202.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$213.75
|
| Rate for Payer: Three Rivers Provider Network All |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$209.25
|
| Rate for Payer: Zelis Auto |
$90.00
|
|
|
IMPLT SCREW 3.5X16MM
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$191.25
|
| Rate for Payer: First Health Commercial |
$202.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$202.50
|
| Rate for Payer: GEHA Commercial |
$157.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$202.50
|
| Rate for Payer: Multiplan All |
$204.75
|
| Rate for Payer: OMNI Networks Commercial |
$157.50
|
| Rate for Payer: One Health Plan PPO/POS |
$202.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$213.75
|
| Rate for Payer: Three Rivers Provider Network All |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$209.25
|
| Rate for Payer: Zelis Auto |
$90.00
|
|
|
IMPLT SCREW 3.5X16MM
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$191.25
|
| Rate for Payer: First Health Commercial |
$202.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$202.50
|
| Rate for Payer: GEHA Commercial |
$180.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$202.50
|
| Rate for Payer: Humana ChoiceCare |
$58.50
|
| Rate for Payer: Multiplan All |
$204.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$135.00
|
| Rate for Payer: OMNI Networks Commercial |
$157.50
|
| Rate for Payer: One Health Plan PPO/POS |
$202.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$213.75
|
| Rate for Payer: Three Rivers Provider Network All |
$168.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$209.25
|
| Rate for Payer: Zelis Auto |
$90.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$112.50
|
|
|
IMPLT SCREW 3.5X18MM
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.80 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$673.60
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$589.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: Zelis Auto |
$336.80
|
|
|
IMPLT SCREW 3.5X18MM
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.50 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$673.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Humana ChoiceCare |
$218.92
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$505.20
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$740.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$210.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: Zelis Auto |
$336.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$421.00
|
|
|
IMPLT SCREW 3.5X20MM
|
Facility
|
OP
|
$2,007.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.75 |
| Max. Negotiated Rate |
$1,906.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$1,705.95
|
| Rate for Payer: First Health Commercial |
$1,806.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,806.30
|
| Rate for Payer: GEHA Commercial |
$1,605.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,806.30
|
| Rate for Payer: Humana ChoiceCare |
$521.82
|
| Rate for Payer: Multiplan All |
$1,826.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,204.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,404.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,806.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,906.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,505.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,766.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$501.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,866.51
|
| Rate for Payer: Zelis Auto |
$802.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,003.50
|
|
|
IMPLT SCREW 3.5X20MM
|
Facility
|
IP
|
$2,007.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$802.80 |
| Max. Negotiated Rate |
$1,906.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,605.60
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$1,705.95
|
| Rate for Payer: First Health Commercial |
$1,806.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,806.30
|
| Rate for Payer: GEHA Commercial |
$1,404.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,806.30
|
| Rate for Payer: Multiplan All |
$1,826.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,404.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,806.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,906.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,505.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,866.51
|
| Rate for Payer: Zelis Auto |
$802.80
|
|
|
IMPLT SCREW 3.5X24MM
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.80 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$673.60
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$589.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: Zelis Auto |
$336.80
|
|
|
IMPLT SCREW 3.5X24MM
|
Facility
|
OP
|
$2,007.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001342
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.75 |
| Max. Negotiated Rate |
$1,906.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$1,705.95
|
| Rate for Payer: First Health Commercial |
$1,806.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,806.30
|
| Rate for Payer: GEHA Commercial |
$1,605.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,806.30
|
| Rate for Payer: Humana ChoiceCare |
$521.82
|
| Rate for Payer: Multiplan All |
$1,826.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,204.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,404.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,806.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,906.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,505.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,766.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$501.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,866.51
|
| Rate for Payer: Zelis Auto |
$802.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,003.50
|
|
|
IMPLT SCREW 3.5X24MM
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.50 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$673.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Humana ChoiceCare |
$218.92
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$505.20
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$740.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$210.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: Zelis Auto |
$336.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$421.00
|
|
|
IMPLT SCREW 3.5X24MM
|
Facility
|
IP
|
$2,007.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001342
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$802.80 |
| Max. Negotiated Rate |
$1,906.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,605.60
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$1,705.95
|
| Rate for Payer: First Health Commercial |
$1,806.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,806.30
|
| Rate for Payer: GEHA Commercial |
$1,404.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,806.30
|
| Rate for Payer: Multiplan All |
$1,826.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,404.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,806.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,906.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,505.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,866.51
|
| Rate for Payer: Zelis Auto |
$802.80
|
|
|
IMPLT SCREW 3.5X26MM
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$199.20
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
|
|
IMPLT SCREW 3.5X26MM
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$64.74
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.40
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$219.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$124.50
|
|
|
IMPLT SCREW 3.5X4.0MM COUNTERSINK
|
Facility
|
OP
|
$2,028.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$1,926.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,216.80
|
| Rate for Payer: Cash Price |
$1,216.80
|
| Rate for Payer: Cash Price |
$1,216.80
|
| Rate for Payer: Cigna Commercial |
$1,723.80
|
| Rate for Payer: First Health Commercial |
$1,825.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,825.20
|
| Rate for Payer: GEHA Commercial |
$1,622.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,825.20
|
| Rate for Payer: Humana ChoiceCare |
$527.28
|
| Rate for Payer: Multiplan All |
$1,845.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,216.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,419.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,825.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,926.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,521.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,784.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$507.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,886.04
|
| Rate for Payer: Zelis Auto |
$811.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.00
|
|
|
IMPLT SCREW 3.5X4.0MM COUNTERSINK
|
Facility
|
IP
|
$2,028.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$811.20 |
| Max. Negotiated Rate |
$1,926.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,622.40
|
| Rate for Payer: Cash Price |
$1,216.80
|
| Rate for Payer: Cash Price |
$1,216.80
|
| Rate for Payer: Cigna Commercial |
$1,723.80
|
| Rate for Payer: First Health Commercial |
$1,825.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,825.20
|
| Rate for Payer: GEHA Commercial |
$1,419.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,825.20
|
| Rate for Payer: Multiplan All |
$1,845.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,419.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,825.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,926.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,521.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,886.04
|
| Rate for Payer: Zelis Auto |
$811.20
|
|
|
IMPLT SCREW 3/8X1 PERMA-PLATED 5 C/S
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
|
|
IMPLT SCREW 3/8X1 PERMA-PLATED 5 C/S
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
|
|
IMPLT SCREW 3MMX40MM
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003504
|
|
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 3MMX40MM
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003504
|
|
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 3X36X7MM CANN THRD
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002752
|
|
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 3X36X7MM CANN THRD
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002752
|
|
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 3X40X8MM CANN THRD
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002751
|
|
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 3X40X8MM CANN THRD
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002751
|
|
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 4.0 CANN P/T 18MM
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$122.40
|
| Rate for Payer: First Health Commercial |
$129.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$129.60
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$129.60
|
| Rate for Payer: Multiplan All |
$131.04
|
| Rate for Payer: OMNI Networks Commercial |
$100.80
|
| Rate for Payer: One Health Plan PPO/POS |
$129.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$136.80
|
| Rate for Payer: Three Rivers Provider Network All |
$108.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$133.92
|
| Rate for Payer: Zelis Auto |
$57.60
|
|
|
IMPLT SCREW 4.0 CANN P/T 18MM
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$122.40
|
| Rate for Payer: First Health Commercial |
$129.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$129.60
|
| Rate for Payer: GEHA Commercial |
$115.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$129.60
|
| Rate for Payer: Humana ChoiceCare |
$37.44
|
| Rate for Payer: Multiplan All |
$131.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$86.40
|
| Rate for Payer: OMNI Networks Commercial |
$100.80
|
| Rate for Payer: One Health Plan PPO/POS |
$129.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$136.80
|
| Rate for Payer: Three Rivers Provider Network All |
$108.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$126.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$133.92
|
| Rate for Payer: Zelis Auto |
$57.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$72.00
|
|
