|
IMPLT SCREW NON LOCKING 2.7X20MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000975
|
|
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 2.7X22MM
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000991
|
|
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 2.7X22MM
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000991
|
|
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 3.0X10MM
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.00 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$820.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$717.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: Zelis Auto |
$410.00
|
|
|
IMPLT SCREW NON LOCKING 3.0X10MM
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.25 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$820.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Humana ChoiceCare |
$266.50
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$615.00
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$902.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$256.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: Zelis Auto |
$410.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$512.50
|
|
|
IMPLT SCREW NON LOCKING,3.5X08MM
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001554
|
|
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,3.5X08MM
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001554
|
|
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 3.5X10MM
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$389.60
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$340.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: Zelis Auto |
$194.80
|
|
|
IMPLT SCREW NON LOCKING 3.5X10MM
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$484.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$423.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
|
|
IMPLT SCREW NON LOCKING 3.5X10MM
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.25 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$484.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Humana ChoiceCare |
$157.30
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$363.00
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$532.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.50
|
|
|
IMPLT SCREW NON LOCKING 3.5X10MM
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.75 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$389.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Humana ChoiceCare |
$126.62
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$292.20
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$428.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: Zelis Auto |
$194.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$243.50
|
|
|
IMPLT SCREW NON LOCKING 3.5X12MM
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$389.60
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$340.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: Zelis Auto |
$194.80
|
|
|
IMPLT SCREW NON LOCKING 3.5X12MM
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.75 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$389.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Humana ChoiceCare |
$126.62
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$292.20
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$428.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: Zelis Auto |
$194.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$243.50
|
|
|
IMPLT SCREW NON LOCKING 3.5X14MM
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.25 |
| Max. Negotiated Rate |
$437.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$391.85
|
| Rate for Payer: First Health Commercial |
$414.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.90
|
| Rate for Payer: GEHA Commercial |
$368.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.90
|
| Rate for Payer: Humana ChoiceCare |
$119.86
|
| Rate for Payer: Multiplan All |
$419.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$276.60
|
| Rate for Payer: OMNI Networks Commercial |
$322.70
|
| Rate for Payer: One Health Plan PPO/POS |
$414.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.95
|
| Rate for Payer: Three Rivers Provider Network All |
$345.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$405.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$428.73
|
| Rate for Payer: Zelis Auto |
$184.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$230.50
|
|
|
IMPLT SCREW NON LOCKING 3.5X14MM
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.40 |
| Max. Negotiated Rate |
$437.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$368.80
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$391.85
|
| Rate for Payer: First Health Commercial |
$414.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.90
|
| Rate for Payer: GEHA Commercial |
$322.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.90
|
| Rate for Payer: Multiplan All |
$419.51
|
| Rate for Payer: OMNI Networks Commercial |
$322.70
|
| Rate for Payer: One Health Plan PPO/POS |
$414.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.95
|
| Rate for Payer: Three Rivers Provider Network All |
$345.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$428.73
|
| Rate for Payer: Zelis Auto |
$184.40
|
|
|
IMPLT SCREW NON LOCKING 3.5X16MM
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.75 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$389.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Humana ChoiceCare |
$126.62
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$292.20
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$428.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: Zelis Auto |
$194.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$243.50
|
|
|
IMPLT SCREW NON LOCKING 3.5X16MM
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$420.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$367.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
|
|
IMPLT SCREW NON LOCKING 3.5X16MM
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Humana ChoiceCare |
$136.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$315.00
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$462.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$131.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$262.50
|
|
|
IMPLT SCREW NON LOCKING 3.5X16MM
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$370.40
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$324.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| Rate for Payer: Multiplan All |
$421.33
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: Zelis Auto |
$185.20
|
|
|
IMPLT SCREW NON LOCKING 3.5X16MM
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.75 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$370.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| Rate for Payer: Humana ChoiceCare |
$120.38
|
| Rate for Payer: Multiplan All |
$421.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$277.80
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$407.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.50
|
|
|
IMPLT SCREW NON LOCKING 3.5X16MM
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$389.60
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$413.95
|
| Rate for Payer: First Health Commercial |
$438.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$438.30
|
| Rate for Payer: GEHA Commercial |
$340.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$438.30
|
| Rate for Payer: Multiplan All |
$443.17
|
| Rate for Payer: OMNI Networks Commercial |
$340.90
|
| Rate for Payer: One Health Plan PPO/POS |
$438.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$462.65
|
| Rate for Payer: Three Rivers Provider Network All |
$365.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$452.91
|
| Rate for Payer: Zelis Auto |
$194.80
|
|
|
IMPLT SCREW NON LOCKING 3.5X18MM
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.00 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$820.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$717.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: Zelis Auto |
$410.00
|
|
|
IMPLT SCREW NON LOCKING 3.5X18MM
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$420.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$367.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
|
|
IMPLT SCREW NON LOCKING 3.5X18MM
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$956.25
|
| Rate for Payer: First Health Commercial |
$1,012.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,012.50
|
| Rate for Payer: GEHA Commercial |
$900.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,012.50
|
| Rate for Payer: Humana ChoiceCare |
$292.50
|
| Rate for Payer: Multiplan All |
$1,023.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$675.00
|
| Rate for Payer: OMNI Networks Commercial |
$787.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,012.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,068.75
|
| Rate for Payer: Three Rivers Provider Network All |
$843.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$990.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$281.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,046.25
|
| Rate for Payer: Zelis Auto |
$450.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$562.50
|
|
|
IMPLT SCREW NON LOCKING 3.5X18MM
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Humana ChoiceCare |
$136.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$315.00
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$462.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$131.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$262.50
|
|
