|
IMPLT SCREW REG 8X20MM
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,047.20
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
|
|
IMPLT SCREW REG 8X25MM
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Humana ChoiceCare |
$340.34
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$785.40
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,151.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$327.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$654.50
|
|
|
IMPLT SCREW REG 8X25MM
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,047.20
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
|
|
IMPLT SCREW REG 8X30MM
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Humana ChoiceCare |
$340.34
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$785.40
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,151.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$327.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$654.50
|
|
|
IMPLT SCREW REG 8X30MM
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,047.20
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
|
|
IMPLT SCREW REG 9X20MM
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Humana ChoiceCare |
$340.34
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$785.40
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,151.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$327.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$654.50
|
|
|
IMPLT SCREW REG 9X20MM
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,047.20
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
|
|
IMPLT SCREW REG 9X25MM
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.25 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$1,012.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$328.90
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$759.00
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,113.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$316.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: Zelis Auto |
$506.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$632.50
|
|
|
IMPLT SCREW REG 9X25MM
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.00 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,012.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$885.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: Zelis Auto |
$506.00
|
|
|
IMPLT SCREW REG 9X30MM
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Humana ChoiceCare |
$340.34
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$785.40
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,151.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$327.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$654.50
|
|
|
IMPLT SCREW REG 9X30MM
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,047.20
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
|
|
IMPLT SCREW REVERSE SYSTEM 4.5-30
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$171.60
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$396.00
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$580.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$330.00
|
|
|
IMPLT SCREW REVERSE SYSTEM 4.5-30
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
|
|
IMPLT SCREW REVERSE SYSTEM 4.5-36
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$171.60
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$396.00
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$580.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$330.00
|
|
|
IMPLT SCREW REVERSE SYSTEM 4.5-36
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
|
|
IMPLT SCREW REVERSE SYSTEM 4.5X24
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$171.60
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$396.00
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$580.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$330.00
|
|
|
IMPLT SCREW REVERSE SYSTEM 4.5X24
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
|
|
IMPLT SCREW SELF TAP 2.0X12MM
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$282.40
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$247.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| Rate for Payer: Multiplan All |
$321.23
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.35
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.29
|
| Rate for Payer: Zelis Auto |
$141.20
|
|
|
IMPLT SCREW SELF TAP 2.0X12MM
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.25 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$282.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| Rate for Payer: Humana ChoiceCare |
$91.78
|
| Rate for Payer: Multiplan All |
$321.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$211.80
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.35
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$310.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$88.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.29
|
| Rate for Payer: Zelis Auto |
$141.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$176.50
|
|
|
IMPLT SCREW SELF TAP 2.7X34MM
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.75 |
| Max. Negotiated Rate |
$785.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$496.20
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cigna Commercial |
$702.95
|
| Rate for Payer: First Health Commercial |
$744.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$744.30
|
| Rate for Payer: GEHA Commercial |
$661.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$744.30
|
| Rate for Payer: Humana ChoiceCare |
$215.02
|
| Rate for Payer: Multiplan All |
$752.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$496.20
|
| Rate for Payer: OMNI Networks Commercial |
$578.90
|
| Rate for Payer: One Health Plan PPO/POS |
$744.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$785.65
|
| Rate for Payer: Three Rivers Provider Network All |
$620.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$727.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$206.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$769.11
|
| Rate for Payer: Zelis Auto |
$330.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$413.50
|
|
|
IMPLT SCREW SELF TAP 2.7X34MM
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.80 |
| Max. Negotiated Rate |
$785.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$661.60
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cigna Commercial |
$702.95
|
| Rate for Payer: First Health Commercial |
$744.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$744.30
|
| Rate for Payer: GEHA Commercial |
$578.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$744.30
|
| Rate for Payer: Multiplan All |
$752.57
|
| Rate for Payer: OMNI Networks Commercial |
$578.90
|
| Rate for Payer: One Health Plan PPO/POS |
$744.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$785.65
|
| Rate for Payer: Three Rivers Provider Network All |
$620.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$769.11
|
| Rate for Payer: Zelis Auto |
$330.80
|
|
|
IMPLT SCREW SELF TAP 3.5X55MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001572
|
|
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 SELF TAP 3.5X55MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001572
|
|
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 SELF TAP 6.5x30
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70090038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$325.20 |
| Max. Negotiated Rate |
$772.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$650.40
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cigna Commercial |
$691.05
|
| Rate for Payer: First Health Commercial |
$731.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$731.70
|
| Rate for Payer: GEHA Commercial |
$569.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$731.70
|
| Rate for Payer: Multiplan All |
$739.83
|
| Rate for Payer: OMNI Networks Commercial |
$569.10
|
| Rate for Payer: One Health Plan PPO/POS |
$731.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$772.35
|
| Rate for Payer: Three Rivers Provider Network All |
$609.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$756.09
|
| Rate for Payer: Zelis Auto |
$325.20
|
|
|
IMPLT SCREW SELF TAP 6.5x30
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70090038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.25 |
| Max. Negotiated Rate |
$772.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cigna Commercial |
$691.05
|
| Rate for Payer: First Health Commercial |
$731.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$731.70
|
| Rate for Payer: GEHA Commercial |
$650.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$731.70
|
| Rate for Payer: Humana ChoiceCare |
$211.38
|
| Rate for Payer: Multiplan All |
$739.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$487.80
|
| Rate for Payer: OMNI Networks Commercial |
$569.10
|
| Rate for Payer: One Health Plan PPO/POS |
$731.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$772.35
|
| Rate for Payer: Three Rivers Provider Network All |
$609.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$715.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$203.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$756.09
|
| Rate for Payer: Zelis Auto |
$325.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.50
|
|
