|
IMPLT SCREW HERB WHIP 3.0MM X 14MM
|
Facility
|
OP
|
$2,159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.75 |
| Max. Negotiated Rate |
$2,051.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,295.40
|
| Rate for Payer: Cash Price |
$1,295.40
|
| Rate for Payer: Cash Price |
$1,295.40
|
| Rate for Payer: Cigna Commercial |
$1,835.15
|
| Rate for Payer: First Health Commercial |
$1,943.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,943.10
|
| Rate for Payer: GEHA Commercial |
$1,727.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,943.10
|
| Rate for Payer: Humana ChoiceCare |
$561.34
|
| Rate for Payer: Multiplan All |
$1,964.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,295.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,511.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,943.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,051.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,619.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,899.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$539.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,007.87
|
| Rate for Payer: Zelis Auto |
$863.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,079.50
|
|
|
IMPLT SCREW HERB WHIP 3.0MM X 14MM
|
Facility
|
IP
|
$2,159.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.60 |
| Max. Negotiated Rate |
$2,051.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,727.20
|
| Rate for Payer: Cash Price |
$1,295.40
|
| Rate for Payer: Cash Price |
$1,295.40
|
| Rate for Payer: Cigna Commercial |
$1,835.15
|
| Rate for Payer: First Health Commercial |
$1,943.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,943.10
|
| Rate for Payer: GEHA Commercial |
$1,511.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,943.10
|
| Rate for Payer: Multiplan All |
$1,964.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,511.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,943.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,051.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,619.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,007.87
|
| Rate for Payer: Zelis Auto |
$863.60
|
|
|
IMPLT SCREW HEXABLE 12X3.5MM
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000897
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$422.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$369.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
|
|
IMPLT SCREW HEXABLE 12X3.5MM
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000897
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$422.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Humana ChoiceCare |
$137.28
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$316.80
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$464.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$132.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.00
|
|
|
IMPLT SCREW HEXALOBE 12X2.3MM
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$422.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Humana ChoiceCare |
$137.28
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$316.80
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$464.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$132.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.00
|
|
|
IMPLT SCREW HEXALOBE 12X2.3MM
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$422.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$369.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
|
|
IMPLT SCREW HEXALOBE 14X3.5MM
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$390.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$328.80
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$349.35
|
| Rate for Payer: First Health Commercial |
$369.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$369.90
|
| Rate for Payer: GEHA Commercial |
$287.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$369.90
|
| Rate for Payer: Multiplan All |
$374.01
|
| Rate for Payer: OMNI Networks Commercial |
$287.70
|
| Rate for Payer: One Health Plan PPO/POS |
$369.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$390.45
|
| Rate for Payer: Three Rivers Provider Network All |
$308.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$382.23
|
| Rate for Payer: Zelis Auto |
$164.40
|
|
|
IMPLT SCREW HEXALOBE 14X3.5MM
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.75 |
| Max. Negotiated Rate |
$390.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$349.35
|
| Rate for Payer: First Health Commercial |
$369.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$369.90
|
| Rate for Payer: GEHA Commercial |
$328.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$369.90
|
| Rate for Payer: Humana ChoiceCare |
$106.86
|
| Rate for Payer: Multiplan All |
$374.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$246.60
|
| Rate for Payer: OMNI Networks Commercial |
$287.70
|
| Rate for Payer: One Health Plan PPO/POS |
$369.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$390.45
|
| Rate for Payer: Three Rivers Provider Network All |
$308.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$361.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$382.23
|
| Rate for Payer: Zelis Auto |
$164.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$205.50
|
|
|
IMPLT SCREW HEXALOBE 2.3X10MM
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$151.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| Rate for Payer: Humana ChoiceCare |
$49.14
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$113.40
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$166.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: Zelis Auto |
$75.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$94.50
|
|
|
IMPLT SCREW HEXALOBE 2.3X10MM
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.20
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: First Health Commercial |
$170.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$170.10
|
| Rate for Payer: GEHA Commercial |
$132.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$170.10
|
| Rate for Payer: Multiplan All |
$171.99
|
| Rate for Payer: OMNI Networks Commercial |
$132.30
|
| Rate for Payer: One Health Plan PPO/POS |
$170.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$179.55
|
| Rate for Payer: Three Rivers Provider Network All |
$141.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$175.77
|
| Rate for Payer: Zelis Auto |
$75.60
|
|
|
IMPLT SCREW HEXALOBE 2.3X18MM
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.00 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$2,070.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Humana ChoiceCare |
$672.88
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,552.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,277.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$647.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,294.00
|
|
|
IMPLT SCREW HEXALOBE 2.3X18MM
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.20 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,070.40
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$1,811.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
|
|
IMPLT SCREW HEXALOBE 3.5X18MM
|
Facility
|
OP
|
$863.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$215.75 |
| Max. Negotiated Rate |
$819.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$517.80
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$733.55
|
| Rate for Payer: First Health Commercial |
$776.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$776.70
|
| Rate for Payer: GEHA Commercial |
$690.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$776.70
|
| Rate for Payer: Humana ChoiceCare |
$224.38
|
| Rate for Payer: Multiplan All |
$785.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$517.80
|
| Rate for Payer: OMNI Networks Commercial |
$604.10
|
| Rate for Payer: One Health Plan PPO/POS |
$776.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$819.85
|
| Rate for Payer: Three Rivers Provider Network All |
$647.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$759.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$215.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$802.59
|
| Rate for Payer: Zelis Auto |
$345.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$431.50
|
|
|
IMPLT SCREW HEXALOBE 3.5X18MM
|
Facility
|
IP
|
$863.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.20 |
| Max. Negotiated Rate |
$819.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$690.40
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$733.55
|
| Rate for Payer: First Health Commercial |
$776.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$776.70
|
| Rate for Payer: GEHA Commercial |
$604.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$776.70
|
| Rate for Payer: Multiplan All |
$785.33
|
| Rate for Payer: OMNI Networks Commercial |
$604.10
|
| Rate for Payer: One Health Plan PPO/POS |
$776.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$819.85
|
| Rate for Payer: Three Rivers Provider Network All |
$647.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$802.59
|
| Rate for Payer: Zelis Auto |
$345.20
|
|
|
IMPLT SCREW HEXALOBE NON-LOCK 3.5X10
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$295.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Humana ChoiceCare |
$95.94
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$221.40
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$324.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$184.50
|
|
|
IMPLT SCREW HEXALOBE NON-LOCK 3.5X10
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$295.20
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$258.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: Zelis Auto |
$147.60
|
|
|
IMPLT SCREW HEXALOBE NON LOCK 3.5X16
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.80 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$673.60
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$589.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: Zelis Auto |
$336.80
|
|
|
IMPLT SCREW HEXALOBE NON LOCK 3.5X16
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.50 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$673.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Humana ChoiceCare |
$218.92
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$505.20
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$740.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$210.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: Zelis Auto |
$336.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$421.00
|
|
|
IMPLT SCREW HEX HEADED 3.5 X 48MM
|
Facility
|
IP
|
$2,790.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.00 |
| Max. Negotiated Rate |
$2,650.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,232.00
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cigna Commercial |
$2,371.50
|
| Rate for Payer: First Health Commercial |
$2,511.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,511.00
|
| Rate for Payer: GEHA Commercial |
$1,953.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,511.00
|
| Rate for Payer: Multiplan All |
$2,538.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,953.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,511.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,650.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,092.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,594.70
|
| Rate for Payer: Zelis Auto |
$1,116.00
|
|
|
IMPLT SCREW HEX HEADED 3.5 X 48MM
|
Facility
|
OP
|
$2,790.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.50 |
| Max. Negotiated Rate |
$2,650.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,674.00
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cigna Commercial |
$2,371.50
|
| Rate for Payer: First Health Commercial |
$2,511.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,511.00
|
| Rate for Payer: GEHA Commercial |
$2,232.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,511.00
|
| Rate for Payer: Humana ChoiceCare |
$725.40
|
| Rate for Payer: Multiplan All |
$2,538.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,674.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,953.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,511.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,650.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,092.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,455.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$697.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,594.70
|
| Rate for Payer: Zelis Auto |
$1,116.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,395.00
|
|
|
IMPLT SCREW HEX LOW PROFILE 6.5X15MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$121.42
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$280.20
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$410.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.50
|
|
|
IMPLT SCREW HEX LOW PROFILE 6.5X15MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.60
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
|
|
IMPLT SCREW HEX LOW PROFILE 6.5X20MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$121.42
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$280.20
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$410.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.50
|
|
|
IMPLT SCREW HEX LOW PROFILE 6.5X20MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.60
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
|
|
IMPLT SCREW HEX LOW PROFILE 6.5X25MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$121.42
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$280.20
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$410.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.50
|
|
