|
IMPLT SCREW 4.0 CANNULATED 48MM
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.20 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$958.40
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$838.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
|
|
IMPLT SCREW 4.0 FULLY THREADED
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,513.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
|
|
IMPLT SCREW 4.0 FULLY THREADED
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,513.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
|
|
IMPLT SCREW 4.0 FULLY THREADED
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.50 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,729.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$562.12
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,297.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,902.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$540.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,081.00
|
|
|
IMPLT SCREW 4.0 FULLY THREADED
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.50 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,729.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$562.12
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,297.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,902.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$540.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,081.00
|
|
|
IMPLT SCREW 4.0MM 34MM
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$1,567.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,320.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,402.50
|
| Rate for Payer: First Health Commercial |
$1,485.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,485.00
|
| Rate for Payer: GEHA Commercial |
$1,155.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,485.00
|
| Rate for Payer: Multiplan All |
$1,501.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,155.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,485.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,567.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,237.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,534.50
|
| Rate for Payer: Zelis Auto |
$660.00
|
|
|
IMPLT SCREW 4.0MM 34MM
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$1,567.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,402.50
|
| Rate for Payer: First Health Commercial |
$1,485.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,485.00
|
| Rate for Payer: GEHA Commercial |
$1,320.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,485.00
|
| Rate for Payer: Humana ChoiceCare |
$429.00
|
| Rate for Payer: Multiplan All |
$1,501.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$990.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,155.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,485.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,567.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,237.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,452.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,534.50
|
| Rate for Payer: Zelis Auto |
$660.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$825.00
|
|
|
IMPLT SCREW 4.0MM CANCELLOUS 14MM
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$151.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| Rate for Payer: Humana ChoiceCare |
$49.14
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$113.40
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$166.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: Zelis Auto |
$75.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$94.50
|
|
|
IMPLT SCREW 4.0MM CANCELLOUS 14MM
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.20
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$132.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: Zelis Auto |
$75.60
|
|
|
IMPLT SCREW 4.0MM CANNULATED
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.75 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$844.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Humana ChoiceCare |
$274.30
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$633.00
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$928.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.50
|
|
|
IMPLT SCREW 4.0MM CANNULATED
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.75 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$844.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Humana ChoiceCare |
$274.30
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$633.00
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$928.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.50
|
|
|
IMPLT SCREW 4.0MM CANNULATED
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$844.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$738.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
|
|
IMPLT SCREW 4.0MM CANNULATED
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$844.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$738.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
|
|
IMPLT SCREW 4.0MM FT 28MM
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.80 |
| Max. Negotiated Rate |
$1,137.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$957.60
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$1,017.45
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,077.30
|
| Rate for Payer: GEHA Commercial |
$837.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,077.30
|
| Rate for Payer: Multiplan All |
$1,089.27
|
| Rate for Payer: OMNI Networks Commercial |
$837.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,077.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,137.15
|
| Rate for Payer: Three Rivers Provider Network All |
$897.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,113.21
|
| Rate for Payer: Zelis Auto |
$478.80
|
|
|
IMPLT SCREW 4.0MM FT 28MM
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$299.25 |
| Max. Negotiated Rate |
$1,137.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.20
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$1,017.45
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,077.30
|
| Rate for Payer: GEHA Commercial |
$957.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,077.30
|
| Rate for Payer: Humana ChoiceCare |
$311.22
|
| Rate for Payer: Multiplan All |
$1,089.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$718.20
|
| Rate for Payer: OMNI Networks Commercial |
$837.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,077.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,137.15
|
| Rate for Payer: Three Rivers Provider Network All |
$897.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,053.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$299.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,113.21
|
| Rate for Payer: Zelis Auto |
$478.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$598.50
|
|
|
IMPLT SCREW 4.0MM FT 40MM
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$299.25 |
| Max. Negotiated Rate |
$1,137.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.20
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$1,017.45
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,077.30
|
| Rate for Payer: GEHA Commercial |
$957.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,077.30
|
| Rate for Payer: Humana ChoiceCare |
$311.22
|
| Rate for Payer: Multiplan All |
$1,089.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$718.20
|
| Rate for Payer: OMNI Networks Commercial |
$837.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,077.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,137.15
|
| Rate for Payer: Three Rivers Provider Network All |
$897.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,053.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$299.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,113.21
|
| Rate for Payer: Zelis Auto |
$478.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$598.50
|
|
|
IMPLT SCREW 4.0MM FT 40MM
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.80 |
| Max. Negotiated Rate |
$1,137.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$957.60
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$1,017.45
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,077.30
|
| Rate for Payer: GEHA Commercial |
$837.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,077.30
|
| Rate for Payer: Multiplan All |
$1,089.27
|
| Rate for Payer: OMNI Networks Commercial |
$837.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,077.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,137.15
|
| Rate for Payer: Three Rivers Provider Network All |
$897.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,113.21
|
| Rate for Payer: Zelis Auto |
$478.80
|
|
|
IMPLT SCREW 4.0X20MM FULLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
|
|
IMPLT SCREW 4.0X20MM FULLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$84.24
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$194.40
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$285.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.00
|
|
|
IMPLT SCREW 4.0X24MM FULLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003342
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
|
|
IMPLT SCREW 4.0X24MM FULLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003342
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$84.24
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$194.40
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$285.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.00
|
|
|
IMPLT SCREW 4.0X26MM FULLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
|
|
IMPLT SCREW 4.0X26MM FULLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$84.24
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$194.40
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$285.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.00
|
|
|
IMPLT SCREW 4.0X28MM CANNULATED
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.20 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$958.40
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$838.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
|
|
IMPLT SCREW 4.0X28MM CANNULATED
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$299.50 |
| Max. Negotiated Rate |
$1,138.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$1,018.30
|
| Rate for Payer: First Health Commercial |
$1,078.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,078.20
|
| Rate for Payer: GEHA Commercial |
$958.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,078.20
|
| Rate for Payer: Humana ChoiceCare |
$311.48
|
| Rate for Payer: Multiplan All |
$1,090.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$718.80
|
| Rate for Payer: OMNI Networks Commercial |
$838.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,078.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,138.10
|
| Rate for Payer: Three Rivers Provider Network All |
$898.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,054.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$299.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,114.14
|
| Rate for Payer: Zelis Auto |
$479.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$599.00
|
|
