|
IMPLT SCREW ASNIS 6.5X8.0MM
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.00 |
| Max. Negotiated Rate |
$1,135.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$956.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cigna Commercial |
$1,015.75
|
| Rate for Payer: First Health Commercial |
$1,075.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,075.50
|
| Rate for Payer: GEHA Commercial |
$836.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,075.50
|
| Rate for Payer: Multiplan All |
$1,087.45
|
| Rate for Payer: OMNI Networks Commercial |
$836.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,075.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,135.25
|
| Rate for Payer: Three Rivers Provider Network All |
$896.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,111.35
|
| Rate for Payer: Zelis Auto |
$478.00
|
|
|
IMPLT SCREW ASNIS 6.5X8.0MM
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.75 |
| Max. Negotiated Rate |
$1,135.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$717.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cigna Commercial |
$1,015.75
|
| Rate for Payer: First Health Commercial |
$1,075.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,075.50
|
| Rate for Payer: GEHA Commercial |
$956.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,075.50
|
| Rate for Payer: Humana ChoiceCare |
$310.70
|
| Rate for Payer: Multiplan All |
$1,087.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$717.00
|
| Rate for Payer: OMNI Networks Commercial |
$836.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,075.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,135.25
|
| Rate for Payer: Three Rivers Provider Network All |
$896.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,051.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$298.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,111.35
|
| Rate for Payer: Zelis Auto |
$478.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$597.50
|
|
|
IMPLT SCREW ASNIS 6.5X95MM
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.75 |
| Max. Negotiated Rate |
$1,135.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$717.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cigna Commercial |
$1,015.75
|
| Rate for Payer: First Health Commercial |
$1,075.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,075.50
|
| Rate for Payer: GEHA Commercial |
$956.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,075.50
|
| Rate for Payer: Humana ChoiceCare |
$310.70
|
| Rate for Payer: Multiplan All |
$1,087.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$717.00
|
| Rate for Payer: OMNI Networks Commercial |
$836.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,075.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,135.25
|
| Rate for Payer: Three Rivers Provider Network All |
$896.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,051.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$298.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,111.35
|
| Rate for Payer: Zelis Auto |
$478.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$597.50
|
|
|
IMPLT SCREW ASNIS 6.5X95MM
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.00 |
| Max. Negotiated Rate |
$1,135.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$956.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cigna Commercial |
$1,015.75
|
| Rate for Payer: First Health Commercial |
$1,075.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,075.50
|
| Rate for Payer: GEHA Commercial |
$836.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,075.50
|
| Rate for Payer: Multiplan All |
$1,087.45
|
| Rate for Payer: OMNI Networks Commercial |
$836.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,075.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,135.25
|
| Rate for Payer: Three Rivers Provider Network All |
$896.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,111.35
|
| Rate for Payer: Zelis Auto |
$478.00
|
|
|
IMPLT SCREW ASNIS 8X100MM
|
Facility
|
IP
|
$1,066.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.40 |
| Max. Negotiated Rate |
$1,012.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$852.80
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cigna Commercial |
$906.10
|
| Rate for Payer: First Health Commercial |
$959.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$959.40
|
| Rate for Payer: GEHA Commercial |
$746.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$959.40
|
| Rate for Payer: Multiplan All |
$970.06
|
| Rate for Payer: OMNI Networks Commercial |
$746.20
|
| Rate for Payer: One Health Plan PPO/POS |
$959.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,012.70
|
| Rate for Payer: Three Rivers Provider Network All |
$799.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$991.38
|
| Rate for Payer: Zelis Auto |
$426.40
|
|
|
IMPLT SCREW ASNIS 8X100MM
|
Facility
|
OP
|
$1,066.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,012.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$639.60
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cigna Commercial |
$906.10
|
| Rate for Payer: First Health Commercial |
$959.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$959.40
|
| Rate for Payer: GEHA Commercial |
$852.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$959.40
|
| Rate for Payer: Humana ChoiceCare |
$277.16
|
| Rate for Payer: Multiplan All |
$970.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$639.60
|
| Rate for Payer: OMNI Networks Commercial |
$746.20
|
| Rate for Payer: One Health Plan PPO/POS |
$959.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,012.70
|
| Rate for Payer: Three Rivers Provider Network All |
$799.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$938.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$991.38
|
| Rate for Payer: Zelis Auto |
$426.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$533.00
|
|
|
IMPLT SCREW ASNIS HIP FEMUR 6.5X55MM
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$342.25 |
| Max. Negotiated Rate |
$1,300.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$1,095.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| Rate for Payer: Humana ChoiceCare |
$355.94
|
| Rate for Payer: Multiplan All |
$1,245.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$821.40
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,300.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,204.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$342.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.17
|
| Rate for Payer: Zelis Auto |
$547.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$684.50
|
|
|
IMPLT SCREW ASNIS HIP FEMUR 6.5X55MM
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.60 |
| Max. Negotiated Rate |
$1,300.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,095.20
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cash Price |
$821.40
|
| Rate for Payer: Cigna Commercial |
$1,163.65
|
| Rate for Payer: First Health Commercial |
$1,232.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,232.10
|
| Rate for Payer: GEHA Commercial |
$958.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,232.10
|
| Rate for Payer: Multiplan All |
$1,245.79
|
| Rate for Payer: OMNI Networks Commercial |
$958.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,232.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,300.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,273.17
|
| Rate for Payer: Zelis Auto |
$547.60
|
|
|
IMPLT SCREW BIOCOMPOSITE 4.75X15MM
|
Facility
|
IP
|
$2,081.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$832.40 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,664.80
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,456.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
|
|
IMPLT SCREW BIOCOMPOSITE 4.75X15MM
|
Facility
|
OP
|
$2,081.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.25 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,664.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Humana ChoiceCare |
$541.06
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,248.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,831.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,040.50
|
|
|
IMPLT SCREW BIOSURE 10094
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$868.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Humana ChoiceCare |
$282.36
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$651.60
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$955.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$543.00
|
|
|
IMPLT SCREW BIOSURE 10094
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$760.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
|
|
IMPLT SCREW BIOSURE 10X30MM
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$868.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Humana ChoiceCare |
$282.36
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$651.60
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$955.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$543.00
|
|
|
IMPLT SCREW BIOSURE 10X30MM
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$760.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
|
|
IMPLT SCREW BIOSURE 10X35
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$868.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Humana ChoiceCare |
$282.36
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$651.60
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$955.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$543.00
|
|
|
IMPLT SCREW BIOSURE 10X35
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$760.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
|
|
IMPLT SCREW BIOSURE 11X30MM
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$760.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
|
|
IMPLT SCREW BIOSURE 11X30MM
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$868.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Humana ChoiceCare |
$282.36
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$651.60
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$955.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$543.00
|
|
|
IMPLT SCREW BIOSURE 11X35MM
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$868.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Humana ChoiceCare |
$282.36
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$651.60
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$955.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$543.00
|
|
|
IMPLT SCREW BIOSURE 11X35MM
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$760.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
|
|
IMPLT SCREW BIOSURE PEEK 8X25MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW BIOSURE PEEK 8X25MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW BIOSURE PEEK 9X35MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW BIOSURE PEEK 9X35MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW BIOSURE REVERSE 6X25
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$923.10
|
| Rate for Payer: First Health Commercial |
$977.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$977.40
|
| Rate for Payer: GEHA Commercial |
$760.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$977.40
|
| Rate for Payer: Multiplan All |
$988.26
|
| Rate for Payer: OMNI Networks Commercial |
$760.20
|
| Rate for Payer: One Health Plan PPO/POS |
$977.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,031.70
|
| Rate for Payer: Three Rivers Provider Network All |
$814.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,009.98
|
| Rate for Payer: Zelis Auto |
$434.40
|
|
