|
IMPLT SCREW MINI ACUTRAK2 24MM
|
Facility
|
OP
|
$2,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.25 |
| Max. Negotiated Rate |
$1,969.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cigna Commercial |
$1,762.05
|
| Rate for Payer: First Health Commercial |
$1,865.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,865.70
|
| Rate for Payer: GEHA Commercial |
$1,658.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,865.70
|
| Rate for Payer: Humana ChoiceCare |
$538.98
|
| Rate for Payer: Multiplan All |
$1,886.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,243.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,451.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,865.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,969.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,554.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,824.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$518.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,927.89
|
| Rate for Payer: Zelis Auto |
$829.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,036.50
|
|
|
IMPLT SCREW MINI ACUTRAK2 24MM
|
Facility
|
IP
|
$2,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$829.20 |
| Max. Negotiated Rate |
$1,969.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cigna Commercial |
$1,762.05
|
| Rate for Payer: First Health Commercial |
$1,865.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,865.70
|
| Rate for Payer: GEHA Commercial |
$1,451.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,865.70
|
| Rate for Payer: Multiplan All |
$1,886.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,451.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,865.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,969.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,554.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,927.89
|
| Rate for Payer: Zelis Auto |
$829.20
|
|
|
IMPLT SCREW MINI FRAG SYNTHES
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$35.36
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$81.60
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.00
|
|
|
IMPLT SCREW MINI FRAG SYNTHES
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
|
|
IMPLT SCREW NON LOCK 15X4.75MM
|
Facility
|
OP
|
$1,090.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.50 |
| Max. Negotiated Rate |
$1,035.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$654.00
|
| Rate for Payer: Cash Price |
$654.00
|
| Rate for Payer: Cash Price |
$654.00
|
| Rate for Payer: Cigna Commercial |
$926.50
|
| Rate for Payer: First Health Commercial |
$981.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$981.00
|
| Rate for Payer: GEHA Commercial |
$872.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$981.00
|
| Rate for Payer: Humana ChoiceCare |
$283.40
|
| Rate for Payer: Multiplan All |
$991.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$654.00
|
| Rate for Payer: OMNI Networks Commercial |
$763.00
|
| Rate for Payer: One Health Plan PPO/POS |
$981.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,035.50
|
| Rate for Payer: Three Rivers Provider Network All |
$817.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$959.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$272.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,013.70
|
| Rate for Payer: Zelis Auto |
$436.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$545.00
|
|
|
IMPLT SCREW NON LOCK 15X4.75MM
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$436.00 |
| Max. Negotiated Rate |
$1,035.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$872.00
|
| Rate for Payer: Cash Price |
$654.00
|
| Rate for Payer: Cash Price |
$654.00
|
| Rate for Payer: Cigna Commercial |
$926.50
|
| Rate for Payer: First Health Commercial |
$981.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$981.00
|
| Rate for Payer: GEHA Commercial |
$763.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$981.00
|
| Rate for Payer: Multiplan All |
$991.90
|
| Rate for Payer: OMNI Networks Commercial |
$763.00
|
| Rate for Payer: One Health Plan PPO/POS |
$981.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,035.50
|
| Rate for Payer: Three Rivers Provider Network All |
$817.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,013.70
|
| Rate for Payer: Zelis Auto |
$436.00
|
|
|
IMPLT SCREW NON LOCK 2.3X10MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.60
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$442.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
|
|
IMPLT SCREW NON LOCK 2.3X10MM
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Humana ChoiceCare |
$164.32
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$379.20
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$556.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$158.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$316.00
|
|
|
IMPLT SCREW NON LOCK 2.3X16MM
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Humana ChoiceCare |
$164.32
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$379.20
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$556.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$158.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$316.00
|
|
|
IMPLT SCREW NON LOCK 2.3X16MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.60
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$442.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
|
|
IMPLT SCREW NON LOCK 2.7X10MM
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.20
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$135.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: Zelis Auto |
$77.60
|
|
|
IMPLT SCREW NON LOCK 2.7X10MM
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$155.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Humana ChoiceCare |
$50.44
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$116.40
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$170.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: Zelis Auto |
$77.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$97.00
|
|
|
IMPLT SCREW NON LOCK 2.7X12MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.60
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$442.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
|
|
IMPLT SCREW NON LOCK 2.7X12MM
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Humana ChoiceCare |
$164.32
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$379.20
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$556.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$158.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$316.00
|
|
|
IMPLT SCREW NON LOCK 3.5X14MM
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.60 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$475.20
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$504.90
|
| Rate for Payer: First Health Commercial |
$534.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$534.60
|
| Rate for Payer: GEHA Commercial |
$415.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$534.60
|
| Rate for Payer: Multiplan All |
$540.54
|
| Rate for Payer: OMNI Networks Commercial |
$415.80
|
| Rate for Payer: One Health Plan PPO/POS |
$534.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$564.30
|
| Rate for Payer: Three Rivers Provider Network All |
$445.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$552.42
|
| Rate for Payer: Zelis Auto |
$237.60
|
|
|
IMPLT SCREW NON LOCK 3.5X14MM
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$504.90
|
| Rate for Payer: First Health Commercial |
$534.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$534.60
|
| Rate for Payer: GEHA Commercial |
$475.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$534.60
|
| Rate for Payer: Humana ChoiceCare |
$154.44
|
| Rate for Payer: Multiplan All |
$540.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$356.40
|
| Rate for Payer: OMNI Networks Commercial |
$415.80
|
| Rate for Payer: One Health Plan PPO/POS |
$534.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$564.30
|
| Rate for Payer: Three Rivers Provider Network All |
$445.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$522.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$552.42
|
| Rate for Payer: Zelis Auto |
$237.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$297.00
|
|
|
IMPLT SCREW NON LOCK 4.75X15MM
|
Facility
|
IP
|
$1,009.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.60 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$807.20
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$706.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: Zelis Auto |
$403.60
|
|
|
IMPLT SCREW NON LOCK 4.75X15MM
|
Facility
|
OP
|
$1,009.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.25 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$807.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| Rate for Payer: Humana ChoiceCare |
$262.34
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$605.40
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$887.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$252.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: Zelis Auto |
$403.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$504.50
|
|
|
IMPLT SCREW NON LOCK 4.75X20MM
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.60 |
| Max. Negotiated Rate |
$1,020.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$859.20
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cigna Commercial |
$912.90
|
| Rate for Payer: First Health Commercial |
$966.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$966.60
|
| Rate for Payer: GEHA Commercial |
$751.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$966.60
|
| Rate for Payer: Multiplan All |
$977.34
|
| Rate for Payer: OMNI Networks Commercial |
$751.80
|
| Rate for Payer: One Health Plan PPO/POS |
$966.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,020.30
|
| Rate for Payer: Three Rivers Provider Network All |
$805.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$998.82
|
| Rate for Payer: Zelis Auto |
$429.60
|
|
|
IMPLT SCREW NON LOCK 4.75X20MM
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.50 |
| Max. Negotiated Rate |
$1,020.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cigna Commercial |
$912.90
|
| Rate for Payer: First Health Commercial |
$966.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$966.60
|
| Rate for Payer: GEHA Commercial |
$859.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$966.60
|
| Rate for Payer: Humana ChoiceCare |
$279.24
|
| Rate for Payer: Multiplan All |
$977.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.40
|
| Rate for Payer: OMNI Networks Commercial |
$751.80
|
| Rate for Payer: One Health Plan PPO/POS |
$966.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,020.30
|
| Rate for Payer: Three Rivers Provider Network All |
$805.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$945.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$268.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$998.82
|
| Rate for Payer: Zelis Auto |
$429.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$537.00
|
|
|
IMPLT SCREW NON LOCK 4.75X25
|
Facility
|
OP
|
$1,009.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.25 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$807.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| Rate for Payer: Humana ChoiceCare |
$262.34
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$605.40
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$887.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$252.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: Zelis Auto |
$403.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$504.50
|
|
|
IMPLT SCREW NON LOCK 4.75X25
|
Facility
|
IP
|
$1,009.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.60 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$807.20
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$706.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: Zelis Auto |
$403.60
|
|
|
IMPLT SCREW NON LOCK,4.75X30MM
|
Facility
|
IP
|
$1,009.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.60 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$807.20
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$706.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: Zelis Auto |
$403.60
|
|
|
IMPLT SCREW NON LOCK,4.75X30MM
|
Facility
|
OP
|
$1,009.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.25 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$807.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| Rate for Payer: Humana ChoiceCare |
$262.34
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$605.40
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$887.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$252.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: Zelis Auto |
$403.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$504.50
|
|
|
IMPLT SCREW NON LOCK 4.75X35MM
|
Facility
|
OP
|
$1,009.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.25 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$807.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| Rate for Payer: Humana ChoiceCare |
$262.34
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$605.40
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$887.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$252.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: Zelis Auto |
$403.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$504.50
|
|
