|
IMPLT SCREW LOCKING 5X8MM PERI
|
Facility
|
IP
|
$1,351.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.40 |
| Max. Negotiated Rate |
$1,283.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,080.80
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$1,148.35
|
| Rate for Payer: First Health Commercial |
$1,215.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,215.90
|
| Rate for Payer: GEHA Commercial |
$945.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,215.90
|
| Rate for Payer: Multiplan All |
$1,229.41
|
| Rate for Payer: OMNI Networks Commercial |
$945.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,215.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,283.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,013.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,256.43
|
| Rate for Payer: Zelis Auto |
$540.40
|
|
|
IMPLT SCREW LOCKING 8MM
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$432.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$378.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
|
|
IMPLT SCREW LOCKING 8MM
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$432.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Humana ChoiceCare |
$140.40
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.00
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$475.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$270.00
|
|
|
IMPLT SCREW LOCKING 90 DEGREE
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.60
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$95.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
|
|
IMPLT SCREW LOCKING 90 DEGREE
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$35.62
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$82.20
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$120.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.50
|
|
|
IMPLT SCREW LOCKING 9MM
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$432.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$378.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
|
|
IMPLT SCREW LOCKING 9MM
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$432.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Humana ChoiceCare |
$140.40
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.00
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$475.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$270.00
|
|
|
IMPLT SCREW LOCKING CRTX 2.7MM 10MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.40
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
|
|
IMPLT SCREW LOCKING CRTX 2.7MM 10MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
|
|
IMPLT SCREW LOCKING FASTPITCH 2.7MM
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,513.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
|
|
IMPLT SCREW LOCKING FASTPITCH 2.7MM
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,513.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
|
|
IMPLT SCREW LOCKING FASTPITCH 2.7MM
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.50 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,729.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$562.12
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,297.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,902.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$540.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,081.00
|
|
|
IMPLT SCREW LOCKING FASTPITCH 2.7MM
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.50 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$1,837.70
|
| Rate for Payer: First Health Commercial |
$1,945.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,945.80
|
| Rate for Payer: GEHA Commercial |
$1,729.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,945.80
|
| Rate for Payer: Humana ChoiceCare |
$562.12
|
| Rate for Payer: Multiplan All |
$1,967.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,297.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,513.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,945.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,053.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,621.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,902.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$540.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,010.66
|
| Rate for Payer: Zelis Auto |
$864.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,081.00
|
|
|
IMPLT SCREW LOCKING FIX-ANGLE 2.4X14MM
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.00 |
| Max. Negotiated Rate |
$1,016.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$856.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cigna Commercial |
$909.50
|
| Rate for Payer: First Health Commercial |
$963.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$963.00
|
| Rate for Payer: GEHA Commercial |
$749.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$963.00
|
| Rate for Payer: Multiplan All |
$973.70
|
| Rate for Payer: OMNI Networks Commercial |
$749.00
|
| Rate for Payer: One Health Plan PPO/POS |
$963.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,016.50
|
| Rate for Payer: Three Rivers Provider Network All |
$802.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$995.10
|
| Rate for Payer: Zelis Auto |
$428.00
|
|
|
IMPLT SCREW LOCKING FIX-ANGLE 2.4X14MM
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.50 |
| Max. Negotiated Rate |
$1,016.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cigna Commercial |
$909.50
|
| Rate for Payer: First Health Commercial |
$963.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$963.00
|
| Rate for Payer: GEHA Commercial |
$856.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$963.00
|
| Rate for Payer: Humana ChoiceCare |
$278.20
|
| Rate for Payer: Multiplan All |
$973.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$642.00
|
| Rate for Payer: OMNI Networks Commercial |
$749.00
|
| Rate for Payer: One Health Plan PPO/POS |
$963.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,016.50
|
| Rate for Payer: Three Rivers Provider Network All |
$802.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$941.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$267.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$995.10
|
| Rate for Payer: Zelis Auto |
$428.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$535.00
|
|
|
IMPLT SCREW LOCKING FIX-ANGLE 2.4X14MM
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.50 |
| Max. Negotiated Rate |
$1,016.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cigna Commercial |
$909.50
|
| Rate for Payer: First Health Commercial |
$963.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$963.00
|
| Rate for Payer: GEHA Commercial |
$856.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$963.00
|
| Rate for Payer: Humana ChoiceCare |
$278.20
|
| Rate for Payer: Multiplan All |
$973.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$642.00
|
| Rate for Payer: OMNI Networks Commercial |
$749.00
|
| Rate for Payer: One Health Plan PPO/POS |
$963.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,016.50
|
| Rate for Payer: Three Rivers Provider Network All |
$802.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$941.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$267.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$995.10
|
| Rate for Payer: Zelis Auto |
$428.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$535.00
|
|
|
IMPLT SCREW LOCKING FIX-ANGLE 2.4X14MM
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.00 |
| Max. Negotiated Rate |
$1,016.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$856.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cigna Commercial |
$909.50
|
| Rate for Payer: First Health Commercial |
$963.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$963.00
|
| Rate for Payer: GEHA Commercial |
$749.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$963.00
|
| Rate for Payer: Multiplan All |
$973.70
|
| Rate for Payer: OMNI Networks Commercial |
$749.00
|
| Rate for Payer: One Health Plan PPO/POS |
$963.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,016.50
|
| Rate for Payer: Three Rivers Provider Network All |
$802.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$995.10
|
| Rate for Payer: Zelis Auto |
$428.00
|
|
|
IMPLT SCREW LOCKING FIX-ANGLE 2.4X16MM
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.60 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$507.20
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$538.90
|
| Rate for Payer: First Health Commercial |
$570.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$570.60
|
| Rate for Payer: GEHA Commercial |
$443.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$570.60
|
| Rate for Payer: Multiplan All |
$576.94
|
| Rate for Payer: OMNI Networks Commercial |
$443.80
|
| Rate for Payer: One Health Plan PPO/POS |
$570.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$602.30
|
| Rate for Payer: Three Rivers Provider Network All |
$475.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$589.62
|
| Rate for Payer: Zelis Auto |
$253.60
|
|
|
IMPLT SCREW LOCKING FIX-ANGLE 2.4X16MM
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.50 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$380.40
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$538.90
|
| Rate for Payer: First Health Commercial |
$570.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$570.60
|
| Rate for Payer: GEHA Commercial |
$507.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$570.60
|
| Rate for Payer: Humana ChoiceCare |
$164.84
|
| Rate for Payer: Multiplan All |
$576.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$380.40
|
| Rate for Payer: OMNI Networks Commercial |
$443.80
|
| Rate for Payer: One Health Plan PPO/POS |
$570.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$602.30
|
| Rate for Payer: Three Rivers Provider Network All |
$475.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$557.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$158.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$589.62
|
| Rate for Payer: Zelis Auto |
$253.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$317.00
|
|
|
IMPLT SCREW LOCKING FIX-ANGLE 2.4X24MM
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$892.50
|
| Rate for Payer: First Health Commercial |
$945.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$945.00
|
| Rate for Payer: GEHA Commercial |
$840.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$945.00
|
| Rate for Payer: Humana ChoiceCare |
$273.00
|
| Rate for Payer: Multiplan All |
$955.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$630.00
|
| Rate for Payer: OMNI Networks Commercial |
$735.00
|
| Rate for Payer: One Health Plan PPO/POS |
$945.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$997.50
|
| Rate for Payer: Three Rivers Provider Network All |
$787.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$924.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$262.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$976.50
|
| Rate for Payer: Zelis Auto |
$420.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$525.00
|
|
|
IMPLT SCREW LOCKING FIX-ANGLE 2.4X24MM
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$840.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$892.50
|
| Rate for Payer: First Health Commercial |
$945.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$945.00
|
| Rate for Payer: GEHA Commercial |
$735.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$945.00
|
| Rate for Payer: Multiplan All |
$955.50
|
| Rate for Payer: OMNI Networks Commercial |
$735.00
|
| Rate for Payer: One Health Plan PPO/POS |
$945.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$997.50
|
| Rate for Payer: Three Rivers Provider Network All |
$787.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$976.50
|
| Rate for Payer: Zelis Auto |
$420.00
|
|
|
IMPLT SCREW LOCKING FIX-ANGLE 2.4X26MM
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$840.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$892.50
|
| Rate for Payer: First Health Commercial |
$945.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$945.00
|
| Rate for Payer: GEHA Commercial |
$735.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$945.00
|
| Rate for Payer: Multiplan All |
$955.50
|
| Rate for Payer: OMNI Networks Commercial |
$735.00
|
| Rate for Payer: One Health Plan PPO/POS |
$945.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$997.50
|
| Rate for Payer: Three Rivers Provider Network All |
$787.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$976.50
|
| Rate for Payer: Zelis Auto |
$420.00
|
|
|
IMPLT SCREW LOCKING FIX-ANGLE 2.4X26MM
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$892.50
|
| Rate for Payer: First Health Commercial |
$945.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$945.00
|
| Rate for Payer: GEHA Commercial |
$840.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$945.00
|
| Rate for Payer: Humana ChoiceCare |
$273.00
|
| Rate for Payer: Multiplan All |
$955.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$630.00
|
| Rate for Payer: OMNI Networks Commercial |
$735.00
|
| Rate for Payer: One Health Plan PPO/POS |
$945.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$997.50
|
| Rate for Payer: Three Rivers Provider Network All |
$787.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$924.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$262.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$976.50
|
| Rate for Payer: Zelis Auto |
$420.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$525.00
|
|
|
IMPLT SCREW LOCKING FIX-ANGLE 2.4X28MM
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$892.50
|
| Rate for Payer: First Health Commercial |
$945.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$945.00
|
| Rate for Payer: GEHA Commercial |
$840.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$945.00
|
| Rate for Payer: Humana ChoiceCare |
$273.00
|
| Rate for Payer: Multiplan All |
$955.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$630.00
|
| Rate for Payer: OMNI Networks Commercial |
$735.00
|
| Rate for Payer: One Health Plan PPO/POS |
$945.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$997.50
|
| Rate for Payer: Three Rivers Provider Network All |
$787.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$924.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$262.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$976.50
|
| Rate for Payer: Zelis Auto |
$420.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$525.00
|
|
|
IMPLT SCREW LOCKING FIX-ANGLE 2.4X28MM
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$840.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$892.50
|
| Rate for Payer: First Health Commercial |
$945.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$945.00
|
| Rate for Payer: GEHA Commercial |
$735.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$945.00
|
| Rate for Payer: Multiplan All |
$955.50
|
| Rate for Payer: OMNI Networks Commercial |
$735.00
|
| Rate for Payer: One Health Plan PPO/POS |
$945.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$997.50
|
| Rate for Payer: Three Rivers Provider Network All |
$787.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$976.50
|
| Rate for Payer: Zelis Auto |
$420.00
|
|
