|
IMPLT SCREW ACUTRAK 2 MICRO 9MM
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.00 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$726.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Humana ChoiceCare |
$236.08
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.80
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$799.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$227.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.00
|
|
|
IMPLT SCREW ACUTRAK 2 MINI 16MM
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.20 |
| Max. Negotiated Rate |
$919.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$774.40
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cigna Commercial |
$822.80
|
| Rate for Payer: First Health Commercial |
$871.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$871.20
|
| Rate for Payer: GEHA Commercial |
$677.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$871.20
|
| Rate for Payer: Multiplan All |
$880.88
|
| Rate for Payer: OMNI Networks Commercial |
$677.60
|
| Rate for Payer: One Health Plan PPO/POS |
$871.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$919.60
|
| Rate for Payer: Three Rivers Provider Network All |
$726.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$900.24
|
| Rate for Payer: Zelis Auto |
$387.20
|
|
|
IMPLT SCREW ACUTRAK 2 MINI 16MM
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$919.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cigna Commercial |
$822.80
|
| Rate for Payer: First Health Commercial |
$871.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$871.20
|
| Rate for Payer: GEHA Commercial |
$774.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$871.20
|
| Rate for Payer: Humana ChoiceCare |
$251.68
|
| Rate for Payer: Multiplan All |
$880.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$580.80
|
| Rate for Payer: OMNI Networks Commercial |
$677.60
|
| Rate for Payer: One Health Plan PPO/POS |
$871.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$919.60
|
| Rate for Payer: Three Rivers Provider Network All |
$726.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$851.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$242.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$900.24
|
| Rate for Payer: Zelis Auto |
$387.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$484.00
|
|
|
IMPLT SCREW ACUTRAK 2 MINI 30MM
|
Facility
|
IP
|
$2,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$829.20 |
| Max. Negotiated Rate |
$1,969.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cigna Commercial |
$1,762.05
|
| Rate for Payer: First Health Commercial |
$1,865.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,865.70
|
| Rate for Payer: GEHA Commercial |
$1,451.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,865.70
|
| Rate for Payer: Multiplan All |
$1,886.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,451.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,865.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,969.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,554.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,927.89
|
| Rate for Payer: Zelis Auto |
$829.20
|
|
|
IMPLT SCREW ACUTRAK 2 MINI 30MM
|
Facility
|
OP
|
$2,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.25 |
| Max. Negotiated Rate |
$1,969.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cigna Commercial |
$1,762.05
|
| Rate for Payer: First Health Commercial |
$1,865.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,865.70
|
| Rate for Payer: GEHA Commercial |
$1,658.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,865.70
|
| Rate for Payer: Humana ChoiceCare |
$538.98
|
| Rate for Payer: Multiplan All |
$1,886.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,243.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,451.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,865.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,969.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,554.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,824.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$518.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,927.89
|
| Rate for Payer: Zelis Auto |
$829.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,036.50
|
|
|
IMPLT SCREW ACUTRAK2 STANDARD 34MM
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$363.20 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$726.40
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$635.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
|
|
IMPLT SCREW ACUTRAK2 STANDARD 34MM
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.00 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$726.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Humana ChoiceCare |
$236.08
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.80
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$799.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$227.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.00
|
|
|
IMPLT SCREW ACUTRAK MICRO 12.0MM BONE
|
Facility
|
OP
|
$1,163.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.75 |
| Max. Negotiated Rate |
$1,104.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$697.80
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cigna Commercial |
$988.55
|
| Rate for Payer: First Health Commercial |
$1,046.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,046.70
|
| Rate for Payer: GEHA Commercial |
$930.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,046.70
|
| Rate for Payer: Humana ChoiceCare |
$302.38
|
| Rate for Payer: Multiplan All |
$1,058.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$697.80
|
| Rate for Payer: OMNI Networks Commercial |
$814.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,046.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,104.85
|
| Rate for Payer: Three Rivers Provider Network All |
$872.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,023.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$290.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,081.59
|
| Rate for Payer: Zelis Auto |
$465.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$581.50
|
|
|
IMPLT SCREW ACUTRAK MICRO 12.0MM BONE
|
Facility
|
IP
|
$1,163.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.20 |
| Max. Negotiated Rate |
$1,104.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$930.40
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cigna Commercial |
$988.55
|
| Rate for Payer: First Health Commercial |
$1,046.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,046.70
|
| Rate for Payer: GEHA Commercial |
$814.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,046.70
|
| Rate for Payer: Multiplan All |
$1,058.33
|
| Rate for Payer: OMNI Networks Commercial |
$814.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,046.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,104.85
|
| Rate for Payer: Three Rivers Provider Network All |
$872.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,081.59
|
| Rate for Payer: Zelis Auto |
$465.20
|
|
|
IMPLT SCREW ACUTRAK STANARD 32MM
|
Facility
|
IP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.60 |
| Max. Negotiated Rate |
$2,250.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,895.20
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cigna Commercial |
$2,013.65
|
| Rate for Payer: First Health Commercial |
$2,132.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,132.10
|
| Rate for Payer: GEHA Commercial |
$1,658.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,132.10
|
| Rate for Payer: Multiplan All |
$2,155.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,658.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,132.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,250.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,776.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,203.17
|
| Rate for Payer: Zelis Auto |
$947.60
|
|
|
IMPLT SCREW ACUTRAK STANARD 32MM
|
Facility
|
OP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.25 |
| Max. Negotiated Rate |
$2,250.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cigna Commercial |
$2,013.65
|
| Rate for Payer: First Health Commercial |
$2,132.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,132.10
|
| Rate for Payer: GEHA Commercial |
$1,895.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,132.10
|
| Rate for Payer: Humana ChoiceCare |
$615.94
|
| Rate for Payer: Multiplan All |
$2,155.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,421.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,658.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,132.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,250.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,776.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,084.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$592.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,203.17
|
| Rate for Payer: Zelis Auto |
$947.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,184.50
|
|
|
IMPLT SCREW ACUTRAK STANDARD 27.5
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$334.80 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$669.60
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$585.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: Zelis Auto |
$334.80
|
|
|
IMPLT SCREW ACUTRAK STANDARD 27.5
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$209.25 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$669.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Humana ChoiceCare |
$217.62
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.20
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$736.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$209.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$418.50
|
|
|
IMPLT SCREW ACUTRAK STANDARD 30MM
|
Facility
|
IP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.60 |
| Max. Negotiated Rate |
$2,250.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,895.20
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cigna Commercial |
$2,013.65
|
| Rate for Payer: First Health Commercial |
$2,132.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,132.10
|
| Rate for Payer: GEHA Commercial |
$1,658.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,132.10
|
| Rate for Payer: Multiplan All |
$2,155.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,658.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,132.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,250.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,776.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,203.17
|
| Rate for Payer: Zelis Auto |
$947.60
|
|
|
IMPLT SCREW ACUTRAK STANDARD 30MM
|
Facility
|
OP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.25 |
| Max. Negotiated Rate |
$2,250.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cigna Commercial |
$2,013.65
|
| Rate for Payer: First Health Commercial |
$2,132.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,132.10
|
| Rate for Payer: GEHA Commercial |
$1,895.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,132.10
|
| Rate for Payer: Humana ChoiceCare |
$615.94
|
| Rate for Payer: Multiplan All |
$2,155.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,421.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,658.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,132.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,250.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,776.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,084.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$592.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,203.17
|
| Rate for Payer: Zelis Auto |
$947.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,184.50
|
|
|
IMPLT SCREW ANCHOR YI 2MM
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.00 |
| Max. Negotiated Rate |
$1,301.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,096.00
|
| Rate for Payer: Cash Price |
$822.00
|
| Rate for Payer: Cash Price |
$822.00
|
| Rate for Payer: Cigna Commercial |
$1,164.50
|
| Rate for Payer: First Health Commercial |
$1,233.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,233.00
|
| Rate for Payer: GEHA Commercial |
$959.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,233.00
|
| Rate for Payer: Multiplan All |
$1,246.70
|
| Rate for Payer: OMNI Networks Commercial |
$959.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,233.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,301.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,027.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,274.10
|
| Rate for Payer: Zelis Auto |
$548.00
|
|
|
IMPLT SCREW ANCHOR YI 2MM
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$342.50 |
| Max. Negotiated Rate |
$1,301.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$822.00
|
| Rate for Payer: Cash Price |
$822.00
|
| Rate for Payer: Cash Price |
$822.00
|
| Rate for Payer: Cigna Commercial |
$1,164.50
|
| Rate for Payer: First Health Commercial |
$1,233.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,233.00
|
| Rate for Payer: GEHA Commercial |
$1,096.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,233.00
|
| Rate for Payer: Humana ChoiceCare |
$356.20
|
| Rate for Payer: Multiplan All |
$1,246.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.00
|
| Rate for Payer: OMNI Networks Commercial |
$959.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,233.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,301.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,027.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,205.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$342.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,274.10
|
| Rate for Payer: Zelis Auto |
$548.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$685.00
|
|
|
IMPLT SCREW ASNIS 6.0 X 50MM ASNIS
|
Facility
|
OP
|
$4,261.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7006759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,065.25 |
| Max. Negotiated Rate |
$4,047.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,556.60
|
| Rate for Payer: Cash Price |
$2,556.60
|
| Rate for Payer: Cash Price |
$2,556.60
|
| Rate for Payer: Cigna Commercial |
$3,621.85
|
| Rate for Payer: First Health Commercial |
$3,834.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,834.90
|
| Rate for Payer: GEHA Commercial |
$3,408.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,834.90
|
| Rate for Payer: Humana ChoiceCare |
$1,107.86
|
| Rate for Payer: Multiplan All |
$3,877.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,556.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,982.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,834.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,047.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,195.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,749.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,065.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,962.73
|
| Rate for Payer: Zelis Auto |
$1,704.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,130.50
|
|
|
IMPLT SCREW ASNIS 6.0 X 50MM ASNIS
|
Facility
|
IP
|
$4,261.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7006759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.40 |
| Max. Negotiated Rate |
$4,047.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,408.80
|
| Rate for Payer: Cash Price |
$2,556.60
|
| Rate for Payer: Cash Price |
$2,556.60
|
| Rate for Payer: Cigna Commercial |
$3,621.85
|
| Rate for Payer: First Health Commercial |
$3,834.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,834.90
|
| Rate for Payer: GEHA Commercial |
$2,982.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,834.90
|
| Rate for Payer: Multiplan All |
$3,877.51
|
| Rate for Payer: OMNI Networks Commercial |
$2,982.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,834.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,047.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,195.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,962.73
|
| Rate for Payer: Zelis Auto |
$1,704.40
|
|
|
IMPLT SCREW ASNIS 6.0 X 60MM ASNIS
|
Facility
|
IP
|
$4,261.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7006758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.40 |
| Max. Negotiated Rate |
$4,047.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,408.80
|
| Rate for Payer: Cash Price |
$2,556.60
|
| Rate for Payer: Cash Price |
$2,556.60
|
| Rate for Payer: Cigna Commercial |
$3,621.85
|
| Rate for Payer: First Health Commercial |
$3,834.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,834.90
|
| Rate for Payer: GEHA Commercial |
$2,982.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,834.90
|
| Rate for Payer: Multiplan All |
$3,877.51
|
| Rate for Payer: OMNI Networks Commercial |
$2,982.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,834.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,047.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,195.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,962.73
|
| Rate for Payer: Zelis Auto |
$1,704.40
|
|
|
IMPLT SCREW ASNIS 6.0 X 60MM ASNIS
|
Facility
|
OP
|
$4,261.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7006758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,065.25 |
| Max. Negotiated Rate |
$4,047.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,556.60
|
| Rate for Payer: Cash Price |
$2,556.60
|
| Rate for Payer: Cash Price |
$2,556.60
|
| Rate for Payer: Cigna Commercial |
$3,621.85
|
| Rate for Payer: First Health Commercial |
$3,834.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,834.90
|
| Rate for Payer: GEHA Commercial |
$3,408.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,834.90
|
| Rate for Payer: Humana ChoiceCare |
$1,107.86
|
| Rate for Payer: Multiplan All |
$3,877.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,556.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,982.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,834.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,047.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,195.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,749.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,065.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,962.73
|
| Rate for Payer: Zelis Auto |
$1,704.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,130.50
|
|
|
IMPLT SCREW ASNIS 6.5MM 75MM
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$334.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$299.20
|
| Rate for Payer: First Health Commercial |
$316.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$316.80
|
| Rate for Payer: GEHA Commercial |
$281.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$316.80
|
| Rate for Payer: Humana ChoiceCare |
$91.52
|
| Rate for Payer: Multiplan All |
$320.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$211.20
|
| Rate for Payer: OMNI Networks Commercial |
$246.40
|
| Rate for Payer: One Health Plan PPO/POS |
$316.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$334.40
|
| Rate for Payer: Three Rivers Provider Network All |
$264.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$309.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$88.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$327.36
|
| Rate for Payer: Zelis Auto |
$140.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$176.00
|
|
|
IMPLT SCREW ASNIS 6.5MM 75MM
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$334.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.60
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$299.20
|
| Rate for Payer: First Health Commercial |
$316.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$316.80
|
| Rate for Payer: GEHA Commercial |
$246.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$316.80
|
| Rate for Payer: Multiplan All |
$320.32
|
| Rate for Payer: OMNI Networks Commercial |
$246.40
|
| Rate for Payer: One Health Plan PPO/POS |
$316.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$334.40
|
| Rate for Payer: Three Rivers Provider Network All |
$264.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$327.36
|
| Rate for Payer: Zelis Auto |
$140.80
|
|
|
IMPLT SCREW ASNIS 6.5MM 85MM
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$334.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$299.20
|
| Rate for Payer: First Health Commercial |
$316.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$316.80
|
| Rate for Payer: GEHA Commercial |
$281.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$316.80
|
| Rate for Payer: Humana ChoiceCare |
$91.52
|
| Rate for Payer: Multiplan All |
$320.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$211.20
|
| Rate for Payer: OMNI Networks Commercial |
$246.40
|
| Rate for Payer: One Health Plan PPO/POS |
$316.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$334.40
|
| Rate for Payer: Three Rivers Provider Network All |
$264.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$309.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$88.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$327.36
|
| Rate for Payer: Zelis Auto |
$140.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$176.00
|
|
|
IMPLT SCREW ASNIS 6.5MM 85MM
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$334.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.60
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$299.20
|
| Rate for Payer: First Health Commercial |
$316.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$316.80
|
| Rate for Payer: GEHA Commercial |
$246.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$316.80
|
| Rate for Payer: Multiplan All |
$320.32
|
| Rate for Payer: OMNI Networks Commercial |
$246.40
|
| Rate for Payer: One Health Plan PPO/POS |
$316.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$334.40
|
| Rate for Payer: Three Rivers Provider Network All |
$264.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$327.36
|
| Rate for Payer: Zelis Auto |
$140.80
|
|
