|
IMPLT SCREW GAMMA LAG TI 10.5X90MM
|
Facility
|
IP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001477
|
|
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 10.5X90MM
|
Facility
|
OP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001477
|
|
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 LOCKING 05X25MM
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.60 |
| Max. Negotiated Rate |
$792.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$667.20
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: First Health Commercial |
$750.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$750.60
|
| Rate for Payer: GEHA Commercial |
$583.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| Rate for Payer: Multiplan All |
$758.94
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$792.30
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$775.62
|
| Rate for Payer: Zelis Auto |
$333.60
|
|
|
IMPLT SCREW GAMMA LOCKING 05X25MM
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$208.50 |
| Max. Negotiated Rate |
$792.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$500.40
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: First Health Commercial |
$750.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$750.60
|
| Rate for Payer: GEHA Commercial |
$667.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| Rate for Payer: Humana ChoiceCare |
$216.84
|
| Rate for Payer: Multiplan All |
$758.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$500.40
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$792.30
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$733.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$775.62
|
| Rate for Payer: Zelis Auto |
$333.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$417.00
|
|
|
IMPLT SCREW GAMMA LOCKING 05X35MM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW GAMMA LOCKING 05X35MM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW GAMMA LOCKING 05X37.5MM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW GAMMA LOCKING 05X37.5MM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW GAMMA LOCKING 05X40MM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW GAMMA LOCKING 05X40MM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW GAMMA LOCKING 05X45MM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW GAMMA LOCKING 05X45MM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW GAMMA LOCKING 5X50MM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW GAMMA LOCKING 5X50MM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW GAMMA LOCKING 5X52.5MM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW GAMMA LOCKING 5X52.5MM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW HA 10X20MM
|
Facility
|
OP
|
$1,119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.75 |
| Max. Negotiated Rate |
$1,063.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna Commercial |
$951.15
|
| Rate for Payer: First Health Commercial |
$1,007.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,007.10
|
| Rate for Payer: GEHA Commercial |
$895.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,007.10
|
| Rate for Payer: Humana ChoiceCare |
$290.94
|
| Rate for Payer: Multiplan All |
$1,018.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$671.40
|
| Rate for Payer: OMNI Networks Commercial |
$783.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,007.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,063.05
|
| Rate for Payer: Three Rivers Provider Network All |
$839.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$984.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,040.67
|
| Rate for Payer: Zelis Auto |
$447.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$559.50
|
|
|
IMPLT SCREW HA 10X20MM
|
Facility
|
IP
|
$1,119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$1,063.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$895.20
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna Commercial |
$951.15
|
| Rate for Payer: First Health Commercial |
$1,007.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,007.10
|
| Rate for Payer: GEHA Commercial |
$783.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,007.10
|
| Rate for Payer: Multiplan All |
$1,018.29
|
| Rate for Payer: OMNI Networks Commercial |
$783.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,007.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,063.05
|
| Rate for Payer: Three Rivers Provider Network All |
$839.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,040.67
|
| Rate for Payer: Zelis Auto |
$447.60
|
|
|
IMPLT SCREW HA 10X25
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000738
|
|
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 HA 10X25
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000738
|
|
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 HA 11X25MM
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000741
|
|
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 HA 11X25MM
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000741
|
|
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 HA 6X20MM
|
Facility
|
IP
|
$1,119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$1,063.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$895.20
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna Commercial |
$951.15
|
| Rate for Payer: First Health Commercial |
$1,007.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,007.10
|
| Rate for Payer: GEHA Commercial |
$783.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,007.10
|
| Rate for Payer: Multiplan All |
$1,018.29
|
| Rate for Payer: OMNI Networks Commercial |
$783.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,007.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,063.05
|
| Rate for Payer: Three Rivers Provider Network All |
$839.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,040.67
|
| Rate for Payer: Zelis Auto |
$447.60
|
|
|
IMPLT SCREW HA 6X20MM
|
Facility
|
OP
|
$1,119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.75 |
| Max. Negotiated Rate |
$1,063.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna Commercial |
$951.15
|
| Rate for Payer: First Health Commercial |
$1,007.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,007.10
|
| Rate for Payer: GEHA Commercial |
$895.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,007.10
|
| Rate for Payer: Humana ChoiceCare |
$290.94
|
| Rate for Payer: Multiplan All |
$1,018.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$671.40
|
| Rate for Payer: OMNI Networks Commercial |
$783.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,007.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,063.05
|
| Rate for Payer: Three Rivers Provider Network All |
$839.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$984.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,040.67
|
| Rate for Payer: Zelis Auto |
$447.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$559.50
|
|
|
IMPLT SCREW HA 6X25MM
|
Facility
|
IP
|
$1,119.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$1,063.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$895.20
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna Commercial |
$951.15
|
| Rate for Payer: First Health Commercial |
$1,007.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,007.10
|
| Rate for Payer: GEHA Commercial |
$783.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,007.10
|
| Rate for Payer: Multiplan All |
$1,018.29
|
| Rate for Payer: OMNI Networks Commercial |
$783.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,007.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,063.05
|
| Rate for Payer: Three Rivers Provider Network All |
$839.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,040.67
|
| Rate for Payer: Zelis Auto |
$447.60
|
|
