|
IMPLT SCREW CORT SELF-TAP 2.4X26MM
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$348.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$261.60
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$383.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$109.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$218.00
|
|
|
IMPLT SCREW CORT SELF-TAP 2.4X28MM
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$348.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$261.60
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$383.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$109.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$218.00
|
|
|
IMPLT SCREW CORT SELF-TAP 2.4X28MM
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$348.80
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$305.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
|
|
IMPLT SCREW CORT SELF-TAP 2.4X8MM
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$348.80
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$305.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
|
|
IMPLT SCREW CORT SELF-TAP 2.4X8MM
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$348.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$261.60
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$383.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$109.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$218.00
|
|
|
IMPLT SCREW CROSS 2.3X15MM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$331.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
|
|
IMPLT SCREW CROSS 2.3X15MM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$379.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Humana ChoiceCare |
$123.24
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$284.40
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$417.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$237.00
|
|
|
IMPLT SCREW CROSSPINS 2.3X16MM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$331.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
|
|
IMPLT SCREW CROSSPINS 2.3X16MM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$379.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Humana ChoiceCare |
$123.24
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$284.40
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$417.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$237.00
|
|
|
IMPLT SCREW CRTX 2.7MM 12MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
|
|
IMPLT SCREW CRTX 2.7MM 12MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.40
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
|
|
IMPLT SCREW CYN CANC FT 4.0 X 16 MM
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$191.20
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$167.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
|
|
IMPLT SCREW CYN CANC FT 4.0 X 16 MM
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.75 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$191.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Humana ChoiceCare |
$62.14
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$143.40
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$210.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$119.50
|
|
|
IMPLT SCREW FRS 14MM 3.0MM DIA
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.25 |
| Max. Negotiated Rate |
$1,213.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$766.20
|
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Cigna Commercial |
$1,085.45
|
| Rate for Payer: First Health Commercial |
$1,149.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,149.30
|
| Rate for Payer: GEHA Commercial |
$1,021.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,149.30
|
| Rate for Payer: Humana ChoiceCare |
$332.02
|
| Rate for Payer: Multiplan All |
$1,162.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$766.20
|
| Rate for Payer: OMNI Networks Commercial |
$893.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,149.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,213.15
|
| Rate for Payer: Three Rivers Provider Network All |
$957.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,123.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$319.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,187.61
|
| Rate for Payer: Zelis Auto |
$510.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$638.50
|
|
|
IMPLT SCREW FRS 14MM 3.0MM DIA
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.80 |
| Max. Negotiated Rate |
$1,213.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,021.60
|
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Cigna Commercial |
$1,085.45
|
| Rate for Payer: First Health Commercial |
$1,149.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,149.30
|
| Rate for Payer: GEHA Commercial |
$893.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,149.30
|
| Rate for Payer: Multiplan All |
$1,162.07
|
| Rate for Payer: OMNI Networks Commercial |
$893.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,149.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,213.15
|
| Rate for Payer: Three Rivers Provider Network All |
$957.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,187.61
|
| Rate for Payer: Zelis Auto |
$510.80
|
|
|
IMPLT SCREW FULL THREAD PEG 2.5X18MM
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$540.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$472.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
|
|
IMPLT SCREW FULL THREAD PEG 2.5X18MM
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Humana ChoiceCare |
$175.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$405.00
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$594.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$337.50
|
|
|
IMPLT SCREW GAMMA 10.5MM
|
Facility
|
OP
|
$2,449.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.25 |
| Max. Negotiated Rate |
$2,326.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,469.40
|
| Rate for Payer: Cash Price |
$1,469.40
|
| Rate for Payer: Cash Price |
$1,469.40
|
| Rate for Payer: Cigna Commercial |
$2,081.65
|
| Rate for Payer: First Health Commercial |
$2,204.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,204.10
|
| Rate for Payer: GEHA Commercial |
$1,959.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,204.10
|
| Rate for Payer: Humana ChoiceCare |
$636.74
|
| Rate for Payer: Multiplan All |
$2,228.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,469.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,714.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,204.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,326.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,836.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,155.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$612.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,277.57
|
| Rate for Payer: Zelis Auto |
$979.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,224.50
|
|
|
IMPLT SCREW GAMMA 10.5MM
|
Facility
|
IP
|
$2,449.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.60 |
| Max. Negotiated Rate |
$2,326.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,959.20
|
| Rate for Payer: Cash Price |
$1,469.40
|
| Rate for Payer: Cash Price |
$1,469.40
|
| Rate for Payer: Cigna Commercial |
$2,081.65
|
| Rate for Payer: First Health Commercial |
$2,204.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,204.10
|
| Rate for Payer: GEHA Commercial |
$1,714.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,204.10
|
| Rate for Payer: Multiplan All |
$2,228.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,714.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,204.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,326.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,836.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,277.57
|
| Rate for Payer: Zelis Auto |
$979.60
|
|
|
IMPLT SCREW GAMMA LAG 10.5X95MM
|
Facility
|
IP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.20 |
| Max. Negotiated Rate |
$2,021.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,702.40
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: First Health Commercial |
$1,915.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,915.20
|
| Rate for Payer: GEHA Commercial |
$1,489.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,915.20
|
| Rate for Payer: Multiplan All |
$1,936.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,489.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,915.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,021.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,596.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,979.04
|
| Rate for Payer: Zelis Auto |
$851.20
|
|
|
IMPLT SCREW GAMMA LAG 10.5X95MM
|
Facility
|
OP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$2,021.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: First Health Commercial |
$1,915.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,915.20
|
| Rate for Payer: GEHA Commercial |
$1,702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,915.20
|
| Rate for Payer: Humana ChoiceCare |
$553.28
|
| Rate for Payer: Multiplan All |
$1,936.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,276.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,489.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,915.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,021.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,596.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,872.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$532.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,979.04
|
| Rate for Payer: Zelis Auto |
$851.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,064.00
|
|
|
IMPLT SCREW GAMMA LAG 10X85MM
|
Facility
|
IP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.20 |
| Max. Negotiated Rate |
$2,021.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,702.40
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: First Health Commercial |
$1,915.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,915.20
|
| Rate for Payer: GEHA Commercial |
$1,489.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,915.20
|
| Rate for Payer: Multiplan All |
$1,936.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,489.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,915.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,021.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,596.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,979.04
|
| Rate for Payer: Zelis Auto |
$851.20
|
|
|
IMPLT SCREW GAMMA LAG 10X85MM
|
Facility
|
OP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$2,021.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: First Health Commercial |
$1,915.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,915.20
|
| Rate for Payer: GEHA Commercial |
$1,702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,915.20
|
| Rate for Payer: Humana ChoiceCare |
$553.28
|
| Rate for Payer: Multiplan All |
$1,936.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,276.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,489.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,915.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,021.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,596.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,872.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$532.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,979.04
|
| Rate for Payer: Zelis Auto |
$851.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,064.00
|
|
|
IMPLT SCREW GAMMA LAG TI 10.5X105MM
|
Facility
|
IP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.20 |
| Max. Negotiated Rate |
$2,021.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,702.40
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: First Health Commercial |
$1,915.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,915.20
|
| Rate for Payer: GEHA Commercial |
$1,489.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,915.20
|
| Rate for Payer: Multiplan All |
$1,936.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,489.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,915.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,021.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,596.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,979.04
|
| Rate for Payer: Zelis Auto |
$851.20
|
|
|
IMPLT SCREW GAMMA LAG TI 10.5X105MM
|
Facility
|
OP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$2,021.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: First Health Commercial |
$1,915.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,915.20
|
| Rate for Payer: GEHA Commercial |
$1,702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,915.20
|
| Rate for Payer: Humana ChoiceCare |
$553.28
|
| Rate for Payer: Multiplan All |
$1,936.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,276.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,489.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,915.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,021.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,596.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,872.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$532.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,979.04
|
| Rate for Payer: Zelis Auto |
$851.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,064.00
|
|
