|
IMPLT SCREW LAG RECON 06.5X90MM
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.00 |
| Max. Negotiated Rate |
$1,144.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$964.00
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cigna Commercial |
$1,024.25
|
| Rate for Payer: First Health Commercial |
$1,084.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,084.50
|
| Rate for Payer: GEHA Commercial |
$843.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,084.50
|
| Rate for Payer: Multiplan All |
$1,096.55
|
| Rate for Payer: OMNI Networks Commercial |
$843.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,084.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,144.75
|
| Rate for Payer: Three Rivers Provider Network All |
$903.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,120.65
|
| Rate for Payer: Zelis Auto |
$482.00
|
|
|
IMPLT SCREW LAG RECON 06.5X90MM
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.25 |
| Max. Negotiated Rate |
$1,144.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$723.00
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cigna Commercial |
$1,024.25
|
| Rate for Payer: First Health Commercial |
$1,084.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,084.50
|
| Rate for Payer: GEHA Commercial |
$964.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,084.50
|
| Rate for Payer: Humana ChoiceCare |
$313.30
|
| Rate for Payer: Multiplan All |
$1,096.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$723.00
|
| Rate for Payer: OMNI Networks Commercial |
$843.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,084.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,144.75
|
| Rate for Payer: Three Rivers Provider Network All |
$903.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,060.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,120.65
|
| Rate for Payer: Zelis Auto |
$482.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.50
|
|
|
IMPLT SCREW, LAG RECON 6.5X80MM
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.00 |
| Max. Negotiated Rate |
$1,144.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$964.00
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cigna Commercial |
$1,024.25
|
| Rate for Payer: First Health Commercial |
$1,084.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,084.50
|
| Rate for Payer: GEHA Commercial |
$843.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,084.50
|
| Rate for Payer: Multiplan All |
$1,096.55
|
| Rate for Payer: OMNI Networks Commercial |
$843.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,084.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,144.75
|
| Rate for Payer: Three Rivers Provider Network All |
$903.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,120.65
|
| Rate for Payer: Zelis Auto |
$482.00
|
|
|
IMPLT SCREW, LAG RECON 6.5X80MM
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.25 |
| Max. Negotiated Rate |
$1,144.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$723.00
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cigna Commercial |
$1,024.25
|
| Rate for Payer: First Health Commercial |
$1,084.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,084.50
|
| Rate for Payer: GEHA Commercial |
$964.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,084.50
|
| Rate for Payer: Humana ChoiceCare |
$313.30
|
| Rate for Payer: Multiplan All |
$1,096.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$723.00
|
| Rate for Payer: OMNI Networks Commercial |
$843.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,084.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,144.75
|
| Rate for Payer: Three Rivers Provider Network All |
$903.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,060.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,120.65
|
| Rate for Payer: Zelis Auto |
$482.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.50
|
|
|
IMPLT SCREW LAG TI 10.5X100MM
|
Facility
|
IP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000554
|
|
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 LAG TI 10.5X100MM
|
Facility
|
OP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000554
|
|
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 LARGE CANNULATED 6.5MM
|
Facility
|
IP
|
$2,412.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.80 |
| Max. Negotiated Rate |
$2,291.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,929.60
|
| Rate for Payer: Cash Price |
$1,447.20
|
| Rate for Payer: Cash Price |
$1,447.20
|
| Rate for Payer: Cigna Commercial |
$2,050.20
|
| Rate for Payer: First Health Commercial |
$2,170.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,170.80
|
| Rate for Payer: GEHA Commercial |
$1,688.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,170.80
|
| Rate for Payer: Multiplan All |
$2,194.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,688.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,170.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,291.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,809.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,243.16
|
| Rate for Payer: Zelis Auto |
$964.80
|
|
|
IMPLT SCREW LARGE CANNULATED 6.5MM
|
Facility
|
OP
|
$2,412.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$603.00 |
| Max. Negotiated Rate |
$2,291.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,447.20
|
| Rate for Payer: Cash Price |
$1,447.20
|
| Rate for Payer: Cash Price |
$1,447.20
|
| Rate for Payer: Cigna Commercial |
$2,050.20
|
| Rate for Payer: First Health Commercial |
$2,170.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,170.80
|
| Rate for Payer: GEHA Commercial |
$1,929.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,170.80
|
| Rate for Payer: Humana ChoiceCare |
$627.12
|
| Rate for Payer: Multiplan All |
$2,194.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,447.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,688.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,170.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,291.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,809.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,122.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$603.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,243.16
|
| Rate for Payer: Zelis Auto |
$964.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,206.00
|
|
|
IMPLT SCREW LCOKING ZPFX 3.5X16
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$496.80
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$527.85
|
| Rate for Payer: First Health Commercial |
$558.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.90
|
| Rate for Payer: GEHA Commercial |
$434.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.90
|
| Rate for Payer: Multiplan All |
$565.11
|
| Rate for Payer: OMNI Networks Commercial |
$434.70
|
| Rate for Payer: One Health Plan PPO/POS |
$558.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$589.95
|
| Rate for Payer: Three Rivers Provider Network All |
$465.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$577.53
|
| Rate for Payer: Zelis Auto |
$248.40
|
|
|
IMPLT SCREW LCOKING ZPFX 3.5X16
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.25 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$527.85
|
| Rate for Payer: First Health Commercial |
$558.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.90
|
| Rate for Payer: GEHA Commercial |
$496.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.90
|
| Rate for Payer: Humana ChoiceCare |
$161.46
|
| Rate for Payer: Multiplan All |
$565.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$372.60
|
| Rate for Payer: OMNI Networks Commercial |
$434.70
|
| Rate for Payer: One Health Plan PPO/POS |
$558.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$589.95
|
| Rate for Payer: Three Rivers Provider Network All |
$465.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$546.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$155.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$577.53
|
| Rate for Payer: Zelis Auto |
$248.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$310.50
|
|
|
IMPLT SCREW LOCK 3.5X24MM
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.40 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$608.80
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$532.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
|
|
IMPLT SCREW LOCK 3.5X24MM
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.25 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$608.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Humana ChoiceCare |
$197.86
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$456.60
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$669.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$190.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$380.50
|
|
|
IMPLT SCREW LOCK 4.5X10MM BLUNT TIP
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$467.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Humana ChoiceCare |
$151.84
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$350.40
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$513.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$146.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$292.00
|
|
|
IMPLT SCREW LOCK 4.5X10MM BLUNT TIP
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$467.20
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$408.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
|
|
IMPLT SCREW LOCK 4.5X18MM
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Humana ChoiceCare |
$276.64
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$638.40
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$936.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$532.00
|
|
|
IMPLT SCREW LOCK 4.5X18MM
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.60 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$851.20
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$744.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
|
|
IMPLT SCREW LOCK 4.5X20MM
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$467.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Humana ChoiceCare |
$151.84
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$350.40
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$513.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$146.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$292.00
|
|
|
IMPLT SCREW LOCK 4.5X20MM
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$467.20
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$408.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
|
|
IMPLT SCREW LOCK 4.5X24MM
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Humana ChoiceCare |
$276.64
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$638.40
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$936.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$532.00
|
|
|
IMPLT SCREW LOCK 4.5X24MM
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.60 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$851.20
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$744.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
|
|
IMPLT SCREW LOCK 4.5X26MM
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000931
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Humana ChoiceCare |
$276.64
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$638.40
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$936.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$532.00
|
|
|
IMPLT SCREW LOCK 4.5X26MM
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000931
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.60 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$851.20
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$744.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
|
|
IMPLT SCREW LOCK 4.5X30MM
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.60 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$851.20
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$744.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
|
|
IMPLT SCREW LOCK 4.5X30MM
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Humana ChoiceCare |
$276.64
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$638.40
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$936.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$532.00
|
|
|
IMPLT SCREW LOCK 4.5X32MM
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$467.20
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$408.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
|
