|
IMPLT SCREW CANNULATED THREADED 4.0X24MM
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002850
|
|
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
|
|
|
IMPLT SCREW CANNULATED THREADED 4.0X30MM
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.00 |
| Max. Negotiated Rate |
$1,059.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$892.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$780.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: Zelis Auto |
$446.00
|
|
|
IMPLT SCREW CANNULATED THREADED 4.0X30MM
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$1,059.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$892.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Humana ChoiceCare |
$289.90
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$669.00
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$981.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$278.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$557.50
|
|
|
IMPLT SCREW CANNULATED THREADED 4.0X36MM
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000801
|
|
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
|
|
|
IMPLT SCREW CANNULATED THREADED 4.0X36MM
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000801
|
|
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 CANNULATED THREADED 4.0X42M
|
Facility
|
IP
|
$1,469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$587.60 |
| Max. Negotiated Rate |
$1,395.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,175.20
|
| Rate for Payer: Cash Price |
$881.40
|
| Rate for Payer: Cash Price |
$881.40
|
| Rate for Payer: Cigna Commercial |
$1,248.65
|
| Rate for Payer: First Health Commercial |
$1,322.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,322.10
|
| Rate for Payer: GEHA Commercial |
$1,028.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,322.10
|
| Rate for Payer: Multiplan All |
$1,336.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,028.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,322.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,395.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,101.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,366.17
|
| Rate for Payer: Zelis Auto |
$587.60
|
|
|
IMPLT SCREW CANNULATED THREADED 4.0X42M
|
Facility
|
OP
|
$1,469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.25 |
| Max. Negotiated Rate |
$1,395.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$881.40
|
| Rate for Payer: Cash Price |
$881.40
|
| Rate for Payer: Cash Price |
$881.40
|
| Rate for Payer: Cigna Commercial |
$1,248.65
|
| Rate for Payer: First Health Commercial |
$1,322.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,322.10
|
| Rate for Payer: GEHA Commercial |
$1,175.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,322.10
|
| Rate for Payer: Humana ChoiceCare |
$381.94
|
| Rate for Payer: Multiplan All |
$1,336.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$881.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,028.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,322.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,395.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,101.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,292.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$367.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,366.17
|
| Rate for Payer: Zelis Auto |
$587.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$734.50
|
|
|
IMPLT SCREW CANNULATED THREADED 4.0X48MM
|
Facility
|
IP
|
$1,469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$587.60 |
| Max. Negotiated Rate |
$1,395.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,175.20
|
| Rate for Payer: Cash Price |
$881.40
|
| Rate for Payer: Cash Price |
$881.40
|
| Rate for Payer: Cigna Commercial |
$1,248.65
|
| Rate for Payer: First Health Commercial |
$1,322.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,322.10
|
| Rate for Payer: GEHA Commercial |
$1,028.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,322.10
|
| Rate for Payer: Multiplan All |
$1,336.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,028.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,322.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,395.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,101.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,366.17
|
| Rate for Payer: Zelis Auto |
$587.60
|
|
|
IMPLT SCREW CANNULATED THREADED 4.0X48MM
|
Facility
|
OP
|
$1,469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.25 |
| Max. Negotiated Rate |
$1,395.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$881.40
|
| Rate for Payer: Cash Price |
$881.40
|
| Rate for Payer: Cash Price |
$881.40
|
| Rate for Payer: Cigna Commercial |
$1,248.65
|
| Rate for Payer: First Health Commercial |
$1,322.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,322.10
|
| Rate for Payer: GEHA Commercial |
$1,175.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,322.10
|
| Rate for Payer: Humana ChoiceCare |
$381.94
|
| Rate for Payer: Multiplan All |
$1,336.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$881.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,028.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,322.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,395.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,101.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,292.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$367.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,366.17
|
| Rate for Payer: Zelis Auto |
$587.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$734.50
|
|
|
IMPLT SCREW CANNULATED TITANIUM 4.0MM
|
Facility
|
IP
|
$1,163.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002555
|
|
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 CANNULATED TITANIUM 4.0MM
|
Facility
|
OP
|
$1,163.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002555
|
|
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 CENTER REUNION 6.5X24MM
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.40
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
|
|
IMPLT SCREW CENTER REUNION 6.5X24MM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.50 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Humana ChoiceCare |
$228.28
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$526.80
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$772.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$439.00
|
|
|
IMPLT SCREW CENTER REUNION 6.5X28MM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.50 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Humana ChoiceCare |
$228.28
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$526.80
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$772.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$439.00
|
|
|
IMPLT SCREW CENTER REUNION 6.5X28MM
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.40
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
|
|
IMPLT SCREW CENTER REUNION 6.5X32MM
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.40
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
|
|
IMPLT SCREW CENTER REUNION 6.5X32MM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.50 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Humana ChoiceCare |
$228.28
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$526.80
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$772.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$439.00
|
|
|
IMPLT SCREW CENTER REUNION 6.5X36MM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.50 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Humana ChoiceCare |
$228.28
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$526.80
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$772.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$439.00
|
|
|
IMPLT SCREW CENTER REUNION 6.5X36MM
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.40
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
|
|
IMPLT SCREW CENTER REUNION 6.5X40MM
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.40
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
|
|
IMPLT SCREW CENTER REUNION 6.5X40MM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.50 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Humana ChoiceCare |
$228.28
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$526.80
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$772.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$439.00
|
|
|
IMPLT SCREW CENTRAL 6.5X25
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna Commercial |
$902.70
|
| Rate for Payer: First Health Commercial |
$955.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$955.80
|
| Rate for Payer: GEHA Commercial |
$849.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$955.80
|
| Rate for Payer: Humana ChoiceCare |
$276.12
|
| Rate for Payer: Multiplan All |
$966.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$637.20
|
| Rate for Payer: OMNI Networks Commercial |
$743.40
|
| Rate for Payer: One Health Plan PPO/POS |
$955.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,008.90
|
| Rate for Payer: Three Rivers Provider Network All |
$796.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$934.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$265.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$987.66
|
| Rate for Payer: Zelis Auto |
$424.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$531.00
|
|
|
IMPLT SCREW CENTRAL 6.5X25
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.80 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$849.60
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna Commercial |
$902.70
|
| Rate for Payer: First Health Commercial |
$955.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$955.80
|
| Rate for Payer: GEHA Commercial |
$743.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$955.80
|
| Rate for Payer: Multiplan All |
$966.42
|
| Rate for Payer: OMNI Networks Commercial |
$743.40
|
| Rate for Payer: One Health Plan PPO/POS |
$955.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,008.90
|
| Rate for Payer: Three Rivers Provider Network All |
$796.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$987.66
|
| Rate for Payer: Zelis Auto |
$424.80
|
|
|
IMPLT SCREW CENTRAL 6.5X30
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.80 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$849.60
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna Commercial |
$902.70
|
| Rate for Payer: First Health Commercial |
$955.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$955.80
|
| Rate for Payer: GEHA Commercial |
$743.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$955.80
|
| Rate for Payer: Multiplan All |
$966.42
|
| Rate for Payer: OMNI Networks Commercial |
$743.40
|
| Rate for Payer: One Health Plan PPO/POS |
$955.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,008.90
|
| Rate for Payer: Three Rivers Provider Network All |
$796.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$987.66
|
| Rate for Payer: Zelis Auto |
$424.80
|
|
|
IMPLT SCREW CENTRAL 6.5X30
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna Commercial |
$902.70
|
| Rate for Payer: First Health Commercial |
$955.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$955.80
|
| Rate for Payer: GEHA Commercial |
$849.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$955.80
|
| Rate for Payer: Humana ChoiceCare |
$276.12
|
| Rate for Payer: Multiplan All |
$966.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$637.20
|
| Rate for Payer: OMNI Networks Commercial |
$743.40
|
| Rate for Payer: One Health Plan PPO/POS |
$955.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,008.90
|
| Rate for Payer: Three Rivers Provider Network All |
$796.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$934.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$265.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$987.66
|
| Rate for Payer: Zelis Auto |
$424.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$531.00
|
|
