|
IMPLT SCREW NON LOCKING 3.5X18MM
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001551
|
|
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 3.5X18MM
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$900.00
|
| 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 |
$787.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,012.50
|
| Rate for Payer: Multiplan All |
$1,023.75
|
| 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: United Payors & United Providers UP&UP |
$1,046.25
|
| Rate for Payer: Zelis Auto |
$450.00
|
|
|
IMPLT SCREW NON LOCKING 3.5X20MM
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000981
|
|
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 3.5X20MM
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000981
|
|
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 3.5X22
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$491.20
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$429.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
|
|
IMPLT SCREW NON LOCKING 3.5X22
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.50 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$491.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Humana ChoiceCare |
$159.64
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$368.40
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$540.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$153.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$307.00
|
|
|
IMPLT SCREW NON LOCKING 3.5X22MM
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000982
|
|
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 3.5X22MM
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000982
|
|
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 3.5X24MM
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$381.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Humana ChoiceCare |
$124.02
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$286.20
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$419.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$238.50
|
|
|
IMPLT SCREW NON LOCKING 3.5X24MM
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$381.60
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$405.45
|
| Rate for Payer: First Health Commercial |
$429.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$429.30
|
| Rate for Payer: GEHA Commercial |
$333.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$429.30
|
| Rate for Payer: Multiplan All |
$434.07
|
| Rate for Payer: OMNI Networks Commercial |
$333.90
|
| Rate for Payer: One Health Plan PPO/POS |
$429.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$453.15
|
| Rate for Payer: Three Rivers Provider Network All |
$357.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$443.61
|
| Rate for Payer: Zelis Auto |
$190.80
|
|
|
IMPLT SCREW NON LOCKING 3.5X24MM
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$113.60
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: First Health Commercial |
$127.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$127.80
|
| Rate for Payer: GEHA Commercial |
$99.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$127.80
|
| Rate for Payer: Multiplan All |
$129.22
|
| Rate for Payer: OMNI Networks Commercial |
$99.40
|
| Rate for Payer: One Health Plan PPO/POS |
$127.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$134.90
|
| Rate for Payer: Three Rivers Provider Network All |
$106.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.06
|
| Rate for Payer: Zelis Auto |
$56.80
|
|
|
IMPLT SCREW NON LOCKING 3.5X24MM
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: First Health Commercial |
$127.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$127.80
|
| Rate for Payer: GEHA Commercial |
$113.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$127.80
|
| Rate for Payer: Humana ChoiceCare |
$36.92
|
| Rate for Payer: Multiplan All |
$129.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$85.20
|
| Rate for Payer: OMNI Networks Commercial |
$99.40
|
| Rate for Payer: One Health Plan PPO/POS |
$127.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$134.90
|
| Rate for Payer: Three Rivers Provider Network All |
$106.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$124.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.06
|
| Rate for Payer: Zelis Auto |
$56.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$71.00
|
|
|
IMPLT SCREW NON LOCKING 3.5X26
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$491.20
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$429.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
|
|
IMPLT SCREW NON LOCKING 3.5X26
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.50 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$491.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Humana ChoiceCare |
$159.64
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$368.40
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$540.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$153.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$307.00
|
|
|
IMPLT SCREW NON LOCKING 3.5X38
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.50 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$491.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Humana ChoiceCare |
$159.64
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$368.40
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$540.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$153.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$307.00
|
|
|
IMPLT SCREW NON LOCKING 3.5X38
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$491.20
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: First Health Commercial |
$552.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$552.60
|
| Rate for Payer: GEHA Commercial |
$429.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$552.60
|
| Rate for Payer: Multiplan All |
$558.74
|
| Rate for Payer: OMNI Networks Commercial |
$429.80
|
| Rate for Payer: One Health Plan PPO/POS |
$552.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$583.30
|
| Rate for Payer: Three Rivers Provider Network All |
$460.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.02
|
| Rate for Payer: Zelis Auto |
$245.60
|
|
|
IMPLT SCREW NON LOCKING 4.75X25MM
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000986
|
|
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 LOCKING 4.75X25MM
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000986
|
|
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-LOCKING 4.75X30MM
|
Facility
|
OP
|
$1,090.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000989
|
|
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-LOCKING 4.75X30MM
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000989
|
|
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 OSTEOPENIA 5.0X12
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW OSTEOPENIA 5.0X12
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW OSTEOPENIA 5.0X14MM
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$888.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$748.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| Rate for Payer: Humana ChoiceCare |
$243.10
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$561.00
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$822.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$233.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: Zelis Auto |
$374.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$467.50
|
|
|
IMPLT SCREW OSTEOPENIA 5.0X14MM
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$888.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$748.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$654.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: Zelis Auto |
$374.00
|
|
|
IMPLT SCREW OSTEOPENIA 5.0X16MM
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$888.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$748.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$654.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: Zelis Auto |
$374.00
|
|
