|
IMPLT SCREW PERI-LOCK 3.5MMX80MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$664.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$594.15
|
| Rate for Payer: First Health Commercial |
$629.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$629.10
|
| Rate for Payer: GEHA Commercial |
$559.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$629.10
|
| Rate for Payer: Humana ChoiceCare |
$181.74
|
| Rate for Payer: Multiplan All |
$636.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$419.40
|
| Rate for Payer: OMNI Networks Commercial |
$489.30
|
| Rate for Payer: One Health Plan PPO/POS |
$629.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$664.05
|
| Rate for Payer: Three Rivers Provider Network All |
$524.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$615.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$174.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$650.07
|
| Rate for Payer: Zelis Auto |
$279.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$349.50
|
|
|
IMPLT SCREW PERI-LOCK 3.5MMX80MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$664.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$559.20
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$594.15
|
| Rate for Payer: First Health Commercial |
$629.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$629.10
|
| Rate for Payer: GEHA Commercial |
$489.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$629.10
|
| Rate for Payer: Multiplan All |
$636.09
|
| Rate for Payer: OMNI Networks Commercial |
$489.30
|
| Rate for Payer: One Health Plan PPO/POS |
$629.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$664.05
|
| Rate for Payer: Three Rivers Provider Network All |
$524.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$650.07
|
| Rate for Payer: Zelis Auto |
$279.60
|
|
|
IMPLT SCREW PERIPHERAL 4.5X16MM
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.40
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
|
|
IMPLT SCREW PERIPHERAL 4.5X16MM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.50 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Humana ChoiceCare |
$228.28
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$526.80
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$772.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$439.00
|
|
|
IMPLT SCREW PERIPHERAL 4.5X24MM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.50 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Humana ChoiceCare |
$228.28
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$526.80
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$772.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$439.00
|
|
|
IMPLT SCREW PERIPHERAL 4.5X24MM
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.40
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
|
|
IMPLT SCREW PERIPHERAL 4.5X28MM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.50 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Humana ChoiceCare |
$228.28
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$526.80
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$772.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$439.00
|
|
|
IMPLT SCREW PERIPHERAL 4.5X28MM
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.40
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
|
|
IMPLT SCREW PERIPHERAL 4.5X32MM
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.40
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
|
|
IMPLT SCREW PERIPHERAL 4.5X32MM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.50 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Humana ChoiceCare |
$228.28
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$526.80
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$772.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$439.00
|
|
|
IMPLT SCREW PERIPHERAL 4.5X36MM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.50 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Humana ChoiceCare |
$228.28
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$526.80
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$772.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$439.00
|
|
|
IMPLT SCREW PERIPHERAL 4.5X36MM
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.40
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
|
|
IMPLT SCREW PERIPHERAL 4.5X40MM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.50 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Humana ChoiceCare |
$228.28
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$526.80
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$772.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$439.00
|
|
|
IMPLT SCREW PERIPHERAL 4.5X40MM
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.40
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
|
|
IMPLT SCREW PERIPHERIAL 4.5X20MM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.50 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Humana ChoiceCare |
$228.28
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$526.80
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$772.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$439.00
|
|
|
IMPLT SCREW PERIPHERIAL 4.5X20MM
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$834.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.40
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: First Health Commercial |
$790.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$790.20
|
| Rate for Payer: GEHA Commercial |
$614.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$790.20
|
| Rate for Payer: Multiplan All |
$798.98
|
| Rate for Payer: OMNI Networks Commercial |
$614.60
|
| Rate for Payer: One Health Plan PPO/POS |
$790.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$834.10
|
| Rate for Payer: Three Rivers Provider Network All |
$658.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$816.54
|
| Rate for Payer: Zelis Auto |
$351.20
|
|
|
IMPLT SCREW PER-LOC 3.5X8MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.40
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
|
|
IMPLT SCREW PER-LOC 3.5X8MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
|
|
IMPLT SCREW PER-LOC CRTX 3.5MMX46
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.40
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
|
|
IMPLT SCREW PER-LOC CRTX 3.5MMX46
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
|
|
IMPLT SCREW PHL PLTD S/M/S/ 8X1-1/2
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$212.80
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$226.10
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$239.40
|
| Rate for Payer: GEHA Commercial |
$186.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$239.40
|
| Rate for Payer: Multiplan All |
$242.06
|
| Rate for Payer: OMNI Networks Commercial |
$186.20
|
| Rate for Payer: One Health Plan PPO/POS |
$239.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$252.70
|
| Rate for Payer: Three Rivers Provider Network All |
$199.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$247.38
|
| Rate for Payer: Zelis Auto |
$106.40
|
|
|
IMPLT SCREW PHL PLTD S/M/S/ 8X1-1/2
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$226.10
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$239.40
|
| Rate for Payer: GEHA Commercial |
$212.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$239.40
|
| Rate for Payer: Humana ChoiceCare |
$69.16
|
| Rate for Payer: Multiplan All |
$242.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$159.60
|
| Rate for Payer: OMNI Networks Commercial |
$186.20
|
| Rate for Payer: One Health Plan PPO/POS |
$239.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$252.70
|
| Rate for Payer: Three Rivers Provider Network All |
$199.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$234.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$247.38
|
| Rate for Payer: Zelis Auto |
$106.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$133.00
|
|
|
IMPLT SCREW PK 6X20MM
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.20
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$842.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
|
|
IMPLT SCREW PK 6X20MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
|
IMPLT SCREW PK 6X25MM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$1,023.40
|
| Rate for Payer: First Health Commercial |
$1,083.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,083.60
|
| Rate for Payer: GEHA Commercial |
$963.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,083.60
|
| Rate for Payer: Humana ChoiceCare |
$313.04
|
| Rate for Payer: Multiplan All |
$1,095.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$722.40
|
| Rate for Payer: OMNI Networks Commercial |
$842.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,083.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,143.80
|
| Rate for Payer: Three Rivers Provider Network All |
$903.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,059.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$301.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,119.72
|
| Rate for Payer: Zelis Auto |
$481.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$602.00
|
|
