|
IMPLT SCREW LOCK PRO-LO 2.7X12MM
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$785.40
|
| Rate for Payer: First Health Commercial |
$831.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$831.60
|
| Rate for Payer: GEHA Commercial |
$739.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$831.60
|
| Rate for Payer: Humana ChoiceCare |
$240.24
|
| Rate for Payer: Multiplan All |
$840.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$554.40
|
| Rate for Payer: OMNI Networks Commercial |
$646.80
|
| Rate for Payer: One Health Plan PPO/POS |
$831.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$877.80
|
| Rate for Payer: Three Rivers Provider Network All |
$693.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$813.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$231.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$859.32
|
| Rate for Payer: Zelis Auto |
$369.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$462.00
|
|
|
IMPLT SCREW LOCK PRO LO 2.7X16MM
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$739.20
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$785.40
|
| Rate for Payer: First Health Commercial |
$831.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$831.60
|
| Rate for Payer: GEHA Commercial |
$646.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$831.60
|
| Rate for Payer: Multiplan All |
$840.84
|
| Rate for Payer: OMNI Networks Commercial |
$646.80
|
| Rate for Payer: One Health Plan PPO/POS |
$831.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$877.80
|
| Rate for Payer: Three Rivers Provider Network All |
$693.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$859.32
|
| Rate for Payer: Zelis Auto |
$369.60
|
|
|
IMPLT SCREW LOCK PRO LO 2.7X16MM
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$785.40
|
| Rate for Payer: First Health Commercial |
$831.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$831.60
|
| Rate for Payer: GEHA Commercial |
$739.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$831.60
|
| Rate for Payer: Humana ChoiceCare |
$240.24
|
| Rate for Payer: Multiplan All |
$840.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$554.40
|
| Rate for Payer: OMNI Networks Commercial |
$646.80
|
| Rate for Payer: One Health Plan PPO/POS |
$831.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$877.80
|
| Rate for Payer: Three Rivers Provider Network All |
$693.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$813.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$231.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$859.32
|
| Rate for Payer: Zelis Auto |
$369.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$462.00
|
|
|
IMPLT SCREW LOCKPRO LO 3.5X10MM
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$785.40
|
| Rate for Payer: First Health Commercial |
$831.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$831.60
|
| Rate for Payer: GEHA Commercial |
$739.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$831.60
|
| Rate for Payer: Humana ChoiceCare |
$240.24
|
| Rate for Payer: Multiplan All |
$840.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$554.40
|
| Rate for Payer: OMNI Networks Commercial |
$646.80
|
| Rate for Payer: One Health Plan PPO/POS |
$831.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$877.80
|
| Rate for Payer: Three Rivers Provider Network All |
$693.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$813.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$231.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$859.32
|
| Rate for Payer: Zelis Auto |
$369.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$462.00
|
|
|
IMPLT SCREW LOCKPRO LO 3.5X10MM
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$739.20
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$785.40
|
| Rate for Payer: First Health Commercial |
$831.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$831.60
|
| Rate for Payer: GEHA Commercial |
$646.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$831.60
|
| Rate for Payer: Multiplan All |
$840.84
|
| Rate for Payer: OMNI Networks Commercial |
$646.80
|
| Rate for Payer: One Health Plan PPO/POS |
$831.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$877.80
|
| Rate for Payer: Three Rivers Provider Network All |
$693.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$859.32
|
| Rate for Payer: Zelis Auto |
$369.60
|
|
|
IMPLT SCREW LOCK THREAD FULL 2.7MMX10MM
|
Facility
|
OP
|
$829.04
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.26 |
| Max. Negotiated Rate |
$787.59 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$497.42
|
| Rate for Payer: Cash Price |
$497.42
|
| Rate for Payer: Cash Price |
$497.42
|
| Rate for Payer: Cigna Commercial |
$704.68
|
| Rate for Payer: First Health Commercial |
$746.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$746.14
|
| Rate for Payer: GEHA Commercial |
$663.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$746.14
|
| Rate for Payer: Humana ChoiceCare |
$215.55
|
| Rate for Payer: Multiplan All |
$754.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$497.42
|
| Rate for Payer: OMNI Networks Commercial |
$580.33
|
| Rate for Payer: One Health Plan PPO/POS |
$746.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$787.59
|
| Rate for Payer: Three Rivers Provider Network All |
$621.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$729.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$207.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$771.01
|
| Rate for Payer: Zelis Auto |
$331.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$414.52
|
|
|
IMPLT SCREW LOCK THREAD FULL 2.7MMX10MM
|
Facility
|
IP
|
$829.04
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$331.62 |
| Max. Negotiated Rate |
$787.59 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$663.23
|
| Rate for Payer: Cash Price |
$497.42
|
| Rate for Payer: Cash Price |
$497.42
|
| Rate for Payer: Cigna Commercial |
$704.68
|
| Rate for Payer: First Health Commercial |
$746.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$746.14
|
| Rate for Payer: GEHA Commercial |
$580.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$746.14
|
| Rate for Payer: Multiplan All |
$754.43
|
| Rate for Payer: OMNI Networks Commercial |
$580.33
|
| Rate for Payer: One Health Plan PPO/POS |
$746.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$787.59
|
| Rate for Payer: Three Rivers Provider Network All |
$621.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$771.01
|
| Rate for Payer: Zelis Auto |
$331.62
|
|
|
IMPLT SCREW LOCK THREAD FULL 2.7MMX12MM
|
Facility
|
IP
|
$829.04
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$331.62 |
| Max. Negotiated Rate |
$787.59 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$663.23
|
| Rate for Payer: Cash Price |
$497.42
|
| Rate for Payer: Cash Price |
$497.42
|
| Rate for Payer: Cigna Commercial |
$704.68
|
| Rate for Payer: First Health Commercial |
$746.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$746.14
|
| Rate for Payer: GEHA Commercial |
$580.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$746.14
|
| Rate for Payer: Multiplan All |
$754.43
|
| Rate for Payer: OMNI Networks Commercial |
$580.33
|
| Rate for Payer: One Health Plan PPO/POS |
$746.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$787.59
|
| Rate for Payer: Three Rivers Provider Network All |
$621.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$771.01
|
| Rate for Payer: Zelis Auto |
$331.62
|
|
|
IMPLT SCREW LOCK THREAD FULL 2.7MMX12MM
|
Facility
|
OP
|
$829.04
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.26 |
| Max. Negotiated Rate |
$787.59 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$497.42
|
| Rate for Payer: Cash Price |
$497.42
|
| Rate for Payer: Cash Price |
$497.42
|
| Rate for Payer: Cigna Commercial |
$704.68
|
| Rate for Payer: First Health Commercial |
$746.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$746.14
|
| Rate for Payer: GEHA Commercial |
$663.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$746.14
|
| Rate for Payer: Humana ChoiceCare |
$215.55
|
| Rate for Payer: Multiplan All |
$754.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$497.42
|
| Rate for Payer: OMNI Networks Commercial |
$580.33
|
| Rate for Payer: One Health Plan PPO/POS |
$746.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$787.59
|
| Rate for Payer: Three Rivers Provider Network All |
$621.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$729.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$207.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$771.01
|
| Rate for Payer: Zelis Auto |
$331.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$414.52
|
|
|
IMPLT SCREW LOW PROFILE
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.00 |
| Max. Negotiated Rate |
$881.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cigna Commercial |
$788.80
|
| Rate for Payer: First Health Commercial |
$835.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$835.20
|
| Rate for Payer: GEHA Commercial |
$742.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$835.20
|
| Rate for Payer: Humana ChoiceCare |
$241.28
|
| Rate for Payer: Multiplan All |
$844.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$556.80
|
| Rate for Payer: OMNI Networks Commercial |
$649.60
|
| Rate for Payer: One Health Plan PPO/POS |
$835.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$881.60
|
| Rate for Payer: Three Rivers Provider Network All |
$696.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$816.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$232.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.04
|
| Rate for Payer: Zelis Auto |
$371.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.00
|
|
|
IMPLT SCREW LOW PROFILE
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.20 |
| Max. Negotiated Rate |
$881.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$742.40
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cigna Commercial |
$788.80
|
| Rate for Payer: First Health Commercial |
$835.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$835.20
|
| Rate for Payer: GEHA Commercial |
$649.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$835.20
|
| Rate for Payer: Multiplan All |
$844.48
|
| Rate for Payer: OMNI Networks Commercial |
$649.60
|
| Rate for Payer: One Health Plan PPO/POS |
$835.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$881.60
|
| Rate for Payer: Three Rivers Provider Network All |
$696.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.04
|
| Rate for Payer: Zelis Auto |
$371.20
|
|
|
IMPLT SCREW LOW PROFILE 5.0X30MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW LOW PROFILE 5.0X30MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW LOW PROFILE 5.0X32.5MM
|
Facility
|
IP
|
$866.65
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.66 |
| Max. Negotiated Rate |
$823.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$693.32
|
| Rate for Payer: Cash Price |
$519.99
|
| Rate for Payer: Cash Price |
$519.99
|
| Rate for Payer: Cigna Commercial |
$736.65
|
| Rate for Payer: First Health Commercial |
$779.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$779.99
|
| Rate for Payer: GEHA Commercial |
$606.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$779.99
|
| Rate for Payer: Multiplan All |
$788.65
|
| Rate for Payer: OMNI Networks Commercial |
$606.65
|
| Rate for Payer: One Health Plan PPO/POS |
$779.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$823.32
|
| Rate for Payer: Three Rivers Provider Network All |
$649.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$805.98
|
| Rate for Payer: Zelis Auto |
$346.66
|
|
|
IMPLT SCREW LOW PROFILE 5.0X32.5MM
|
Facility
|
OP
|
$866.65
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.66 |
| Max. Negotiated Rate |
$823.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$519.99
|
| Rate for Payer: Cash Price |
$519.99
|
| Rate for Payer: Cash Price |
$519.99
|
| Rate for Payer: Cigna Commercial |
$736.65
|
| Rate for Payer: First Health Commercial |
$779.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$779.99
|
| Rate for Payer: GEHA Commercial |
$693.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$779.99
|
| Rate for Payer: Humana ChoiceCare |
$225.33
|
| Rate for Payer: Multiplan All |
$788.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$519.99
|
| Rate for Payer: OMNI Networks Commercial |
$606.65
|
| Rate for Payer: One Health Plan PPO/POS |
$779.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$823.32
|
| Rate for Payer: Three Rivers Provider Network All |
$649.99
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$762.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$216.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$805.98
|
| Rate for Payer: Zelis Auto |
$346.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$433.32
|
|
|
IMPLT SCREW LOW PROFILE 5.0X55MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW LOW PROFILE 5.0X55MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW LOW PROFILE 6.5X15MM
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.20 |
| Max. Negotiated Rate |
$881.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$742.40
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cigna Commercial |
$788.80
|
| Rate for Payer: First Health Commercial |
$835.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$835.20
|
| Rate for Payer: GEHA Commercial |
$649.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$835.20
|
| Rate for Payer: Multiplan All |
$844.48
|
| Rate for Payer: OMNI Networks Commercial |
$649.60
|
| Rate for Payer: One Health Plan PPO/POS |
$835.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$881.60
|
| Rate for Payer: Three Rivers Provider Network All |
$696.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.04
|
| Rate for Payer: Zelis Auto |
$371.20
|
|
|
IMPLT SCREW LOW PROFILE 6.5X15MM
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.00 |
| Max. Negotiated Rate |
$881.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cigna Commercial |
$788.80
|
| Rate for Payer: First Health Commercial |
$835.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$835.20
|
| Rate for Payer: GEHA Commercial |
$742.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$835.20
|
| Rate for Payer: Humana ChoiceCare |
$241.28
|
| Rate for Payer: Multiplan All |
$844.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$556.80
|
| Rate for Payer: OMNI Networks Commercial |
$649.60
|
| Rate for Payer: One Health Plan PPO/POS |
$835.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$881.60
|
| Rate for Payer: Three Rivers Provider Network All |
$696.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$816.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$232.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.04
|
| Rate for Payer: Zelis Auto |
$371.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.00
|
|
|
IMPLT SCREW MAC.FL HD PHIL12-24X1/2
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
|
|
IMPLT SCREW MAC.FL HD PHIL12-24X1/2
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
|
|
IMPLT SCREW MICRO ACUTRAK 10MM
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$363.20 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$726.40
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$635.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
|
|
IMPLT SCREW MICRO ACUTRAK 10MM
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.00 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$726.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Humana ChoiceCare |
$236.08
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.80
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$799.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$227.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.00
|
|
|
IMPLT SCREW MINI 26MM
|
Facility
|
OP
|
$3,036.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$759.00 |
| Max. Negotiated Rate |
$2,884.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cigna Commercial |
$2,580.60
|
| Rate for Payer: First Health Commercial |
$2,732.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,732.40
|
| Rate for Payer: GEHA Commercial |
$2,428.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$789.36
|
| Rate for Payer: Multiplan All |
$2,762.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,821.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,125.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,732.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,884.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,277.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,671.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$759.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,823.48
|
| Rate for Payer: Zelis Auto |
$1,214.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,518.00
|
|
|
IMPLT SCREW MINI 26MM
|
Facility
|
IP
|
$3,036.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,214.40 |
| Max. Negotiated Rate |
$2,884.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,428.80
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cigna Commercial |
$2,580.60
|
| Rate for Payer: First Health Commercial |
$2,732.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,732.40
|
| Rate for Payer: GEHA Commercial |
$2,125.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,732.40
|
| Rate for Payer: Multiplan All |
$2,762.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,125.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,732.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,884.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,277.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,823.48
|
| Rate for Payer: Zelis Auto |
$1,214.40
|
|
