|
IMPLT SCREW NON LOCK 4.75X35MM
|
Facility
|
IP
|
$1,009.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001546
|
|
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 LOCKING 1.7X12MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW NON LOCKING 1.7X12MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW NON LOCKING 1.7X5MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW NON LOCKING 1.7X5MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW NON LOCKING 1.7X6MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW NON LOCKING 1.7X6MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW NON LOCKING 1.7X9MM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$377.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Humana ChoiceCare |
$122.72
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$283.20
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$415.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$236.00
|
|
|
IMPLT SCREW NON LOCKING 1.7X9MM
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$377.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$401.20
|
| Rate for Payer: First Health Commercial |
$424.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$424.80
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$424.80
|
| Rate for Payer: Multiplan All |
$429.52
|
| Rate for Payer: OMNI Networks Commercial |
$330.40
|
| Rate for Payer: One Health Plan PPO/POS |
$424.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$448.40
|
| Rate for Payer: Three Rivers Provider Network All |
$354.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.96
|
| Rate for Payer: Zelis Auto |
$188.80
|
|
|
IMPLT SCREW NON-LOCKING 2.0 X 10
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$482.40
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$512.55
|
| Rate for Payer: First Health Commercial |
$542.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.70
|
| Rate for Payer: GEHA Commercial |
$422.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.70
|
| Rate for Payer: Multiplan All |
$548.73
|
| Rate for Payer: OMNI Networks Commercial |
$422.10
|
| Rate for Payer: One Health Plan PPO/POS |
$542.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.85
|
| Rate for Payer: Three Rivers Provider Network All |
$452.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.79
|
| Rate for Payer: Zelis Auto |
$241.20
|
|
|
IMPLT SCREW NON-LOCKING 2.0 X 10
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$512.55
|
| Rate for Payer: First Health Commercial |
$542.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.70
|
| Rate for Payer: GEHA Commercial |
$482.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.70
|
| Rate for Payer: Humana ChoiceCare |
$156.78
|
| Rate for Payer: Multiplan All |
$548.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$361.80
|
| Rate for Payer: OMNI Networks Commercial |
$422.10
|
| Rate for Payer: One Health Plan PPO/POS |
$542.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.85
|
| Rate for Payer: Three Rivers Provider Network All |
$452.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$530.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.79
|
| Rate for Payer: Zelis Auto |
$241.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$301.50
|
|
|
IMPLT SCREW NON-LOCKING 2.0 X 11
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$512.55
|
| Rate for Payer: First Health Commercial |
$542.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.70
|
| Rate for Payer: GEHA Commercial |
$482.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.70
|
| Rate for Payer: Humana ChoiceCare |
$156.78
|
| Rate for Payer: Multiplan All |
$548.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$361.80
|
| Rate for Payer: OMNI Networks Commercial |
$422.10
|
| Rate for Payer: One Health Plan PPO/POS |
$542.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.85
|
| Rate for Payer: Three Rivers Provider Network All |
$452.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$530.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.79
|
| Rate for Payer: Zelis Auto |
$241.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$301.50
|
|
|
IMPLT SCREW NON-LOCKING 2.0 X 11
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$482.40
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$512.55
|
| Rate for Payer: First Health Commercial |
$542.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.70
|
| Rate for Payer: GEHA Commercial |
$422.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.70
|
| Rate for Payer: Multiplan All |
$548.73
|
| Rate for Payer: OMNI Networks Commercial |
$422.10
|
| Rate for Payer: One Health Plan PPO/POS |
$542.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.85
|
| Rate for Payer: Three Rivers Provider Network All |
$452.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.79
|
| Rate for Payer: Zelis Auto |
$241.20
|
|
|
IMPLT SCREW NON LOCKING 2.3X14MM
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.75 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$199.75
|
| Rate for Payer: First Health Commercial |
$211.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$211.50
|
| Rate for Payer: GEHA Commercial |
$188.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$211.50
|
| Rate for Payer: Humana ChoiceCare |
$61.10
|
| Rate for Payer: Multiplan All |
$213.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$141.00
|
| Rate for Payer: OMNI Networks Commercial |
$164.50
|
| Rate for Payer: One Health Plan PPO/POS |
$211.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$223.25
|
| Rate for Payer: Three Rivers Provider Network All |
$176.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$206.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$58.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$218.55
|
| Rate for Payer: Zelis Auto |
$94.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$117.50
|
|
|
IMPLT SCREW NON LOCKING 2.3X14MM
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$188.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$199.75
|
| Rate for Payer: First Health Commercial |
$211.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$211.50
|
| Rate for Payer: GEHA Commercial |
$164.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$211.50
|
| Rate for Payer: Multiplan All |
$213.85
|
| Rate for Payer: OMNI Networks Commercial |
$164.50
|
| Rate for Payer: One Health Plan PPO/POS |
$211.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$223.25
|
| Rate for Payer: Three Rivers Provider Network All |
$176.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$218.55
|
| Rate for Payer: Zelis Auto |
$94.00
|
|
|
IMPLT SCREW NON LOCKING 2.3X14MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000606
|
|
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 LOCKING 2.3X14MM
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000606
|
|
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 LOCKING 2.3X18MM
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000984
|
|
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 LOCKING 2.3X18MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000984
|
|
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 LOCKING 2.3X20MM
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$188.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$199.75
|
| Rate for Payer: First Health Commercial |
$211.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$211.50
|
| Rate for Payer: GEHA Commercial |
$164.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$211.50
|
| Rate for Payer: Multiplan All |
$213.85
|
| Rate for Payer: OMNI Networks Commercial |
$164.50
|
| Rate for Payer: One Health Plan PPO/POS |
$211.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$223.25
|
| Rate for Payer: Three Rivers Provider Network All |
$176.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$218.55
|
| Rate for Payer: Zelis Auto |
$94.00
|
|
|
IMPLT SCREW NON LOCKING 2.3X20MM
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.75 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$199.75
|
| Rate for Payer: First Health Commercial |
$211.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$211.50
|
| Rate for Payer: GEHA Commercial |
$188.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$211.50
|
| Rate for Payer: Humana ChoiceCare |
$61.10
|
| Rate for Payer: Multiplan All |
$213.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$141.00
|
| Rate for Payer: OMNI Networks Commercial |
$164.50
|
| Rate for Payer: One Health Plan PPO/POS |
$211.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$223.25
|
| Rate for Payer: Three Rivers Provider Network All |
$176.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$206.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$58.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$218.55
|
| Rate for Payer: Zelis Auto |
$94.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$117.50
|
|
|
IMPLT SCREW NON LOCKING 2.3X28MM
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.75 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$199.75
|
| Rate for Payer: First Health Commercial |
$211.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$211.50
|
| Rate for Payer: GEHA Commercial |
$188.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$211.50
|
| Rate for Payer: Humana ChoiceCare |
$61.10
|
| Rate for Payer: Multiplan All |
$213.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$141.00
|
| Rate for Payer: OMNI Networks Commercial |
$164.50
|
| Rate for Payer: One Health Plan PPO/POS |
$211.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$223.25
|
| Rate for Payer: Three Rivers Provider Network All |
$176.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$206.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$58.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$218.55
|
| Rate for Payer: Zelis Auto |
$94.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$117.50
|
|
|
IMPLT SCREW NON LOCKING 2.3X28MM
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$188.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$199.75
|
| Rate for Payer: First Health Commercial |
$211.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$211.50
|
| Rate for Payer: GEHA Commercial |
$164.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$211.50
|
| Rate for Payer: Multiplan All |
$213.85
|
| Rate for Payer: OMNI Networks Commercial |
$164.50
|
| Rate for Payer: One Health Plan PPO/POS |
$211.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$223.25
|
| Rate for Payer: Three Rivers Provider Network All |
$176.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$218.55
|
| Rate for Payer: Zelis Auto |
$94.00
|
|
|
IMPLT SCREW NON-LOCKING 2.3X28MM
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.25 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$676.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Humana ChoiceCare |
$219.70
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$507.00
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$743.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$211.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$422.50
|
|
|
IMPLT SCREW NON-LOCKING 2.3X28MM
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$676.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$591.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
|
