|
IMPLT SCREW SELF TAP 6.5x30
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70090039
|
|
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 |
70090039
|
|
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
|
|
|
IMPLT SCREW SELF TAP LOCK
|
Facility
|
IP
|
$7,156.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70090037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,862.40 |
| Max. Negotiated Rate |
$6,798.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,724.80
|
| Rate for Payer: Cash Price |
$4,293.60
|
| Rate for Payer: Cash Price |
$4,293.60
|
| Rate for Payer: Cigna Commercial |
$6,082.60
|
| Rate for Payer: First Health Commercial |
$6,440.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,440.40
|
| Rate for Payer: GEHA Commercial |
$5,009.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,440.40
|
| Rate for Payer: Multiplan All |
$6,511.96
|
| Rate for Payer: OMNI Networks Commercial |
$5,009.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,440.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,798.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,367.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,655.08
|
| Rate for Payer: Zelis Auto |
$2,862.40
|
|
|
IMPLT SCREW SELF TAP LOCK
|
Facility
|
OP
|
$7,156.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70090037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,789.00 |
| Max. Negotiated Rate |
$6,798.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,293.60
|
| Rate for Payer: Cash Price |
$4,293.60
|
| Rate for Payer: Cash Price |
$4,293.60
|
| Rate for Payer: Cigna Commercial |
$6,082.60
|
| Rate for Payer: First Health Commercial |
$6,440.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,440.40
|
| Rate for Payer: GEHA Commercial |
$5,724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,440.40
|
| Rate for Payer: Humana ChoiceCare |
$1,860.56
|
| Rate for Payer: Multiplan All |
$6,511.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,293.60
|
| Rate for Payer: OMNI Networks Commercial |
$5,009.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,440.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,798.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,367.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,297.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,789.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,655.08
|
| Rate for Payer: Zelis Auto |
$2,862.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,578.00
|
|
|
IMPLT SCREW SELF TAP LOCK 2.7X16MM
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$696.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Humana ChoiceCare |
$226.46
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$522.60
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$766.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$217.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$435.50
|
|
|
IMPLT SCREW SELF TAP LOCK 2.7X16MM
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.80
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$609.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
|
|
IMPLT SCREW SELF TAP LOCK 2.7X18MM
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.75 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$725.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Humana ChoiceCare |
$235.82
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.20
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$798.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.50
|
|
|
IMPLT SCREW SELF TAP LOCK 2.7X18MM
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.80 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$725.60
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$634.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
|
|
IMPLT SCREW SELF TAP LOCK 2.7X34MM
|
Facility
|
IP
|
$691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$656.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$552.80
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$587.35
|
| Rate for Payer: First Health Commercial |
$621.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.90
|
| Rate for Payer: GEHA Commercial |
$483.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.90
|
| Rate for Payer: Multiplan All |
$628.81
|
| Rate for Payer: OMNI Networks Commercial |
$483.70
|
| Rate for Payer: One Health Plan PPO/POS |
$621.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$656.45
|
| Rate for Payer: Three Rivers Provider Network All |
$518.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$642.63
|
| Rate for Payer: Zelis Auto |
$276.40
|
|
|
IMPLT SCREW SELF TAP LOCK 2.7X34MM
|
Facility
|
OP
|
$691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$656.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$587.35
|
| Rate for Payer: First Health Commercial |
$621.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.90
|
| Rate for Payer: GEHA Commercial |
$552.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.90
|
| Rate for Payer: Humana ChoiceCare |
$179.66
|
| Rate for Payer: Multiplan All |
$628.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$414.60
|
| Rate for Payer: OMNI Networks Commercial |
$483.70
|
| Rate for Payer: One Health Plan PPO/POS |
$621.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$656.45
|
| Rate for Payer: Three Rivers Provider Network All |
$518.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$608.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$172.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$642.63
|
| Rate for Payer: Zelis Auto |
$276.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$345.50
|
|
|
IMPLT SCREW SELF TAP LOCK 3.5X18MM
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$588.80
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$515.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| Rate for Payer: Multiplan All |
$669.76
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$699.20
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$684.48
|
| Rate for Payer: Zelis Auto |
$294.40
|
|
|
IMPLT SCREW SELF TAP LOCK 3.5X18MM
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.00 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$588.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| Rate for Payer: Humana ChoiceCare |
$191.36
|
| Rate for Payer: Multiplan All |
$669.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$441.60
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$699.20
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$647.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$184.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$684.48
|
| Rate for Payer: Zelis Auto |
$294.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$368.00
|
|
|
IMPLT SCREW SELF TAPPING 2.7X18MM
|
Facility
|
OP
|
$2,695.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.75 |
| Max. Negotiated Rate |
$2,560.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna Commercial |
$2,290.75
|
| Rate for Payer: First Health Commercial |
$2,425.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,425.50
|
| Rate for Payer: GEHA Commercial |
$2,156.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,425.50
|
| Rate for Payer: Humana ChoiceCare |
$700.70
|
| Rate for Payer: Multiplan All |
$2,452.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,617.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,886.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,425.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,560.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,021.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,371.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$673.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,506.35
|
| Rate for Payer: Zelis Auto |
$1,078.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,347.50
|
|
|
IMPLT SCREW SELF TAPPING 2.7X18MM
|
Facility
|
IP
|
$2,695.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.00 |
| Max. Negotiated Rate |
$2,560.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,156.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna Commercial |
$2,290.75
|
| Rate for Payer: First Health Commercial |
$2,425.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,425.50
|
| Rate for Payer: GEHA Commercial |
$1,886.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,425.50
|
| Rate for Payer: Multiplan All |
$2,452.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,886.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,425.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,560.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,021.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,506.35
|
| Rate for Payer: Zelis Auto |
$1,078.00
|
|
|
IMPLT SCREW SELF TAPPING 4MM
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.60
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$316.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
|
|
IMPLT SCREW SELF TAPPING 4MM
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$361.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Humana ChoiceCare |
$117.52
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$271.20
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$397.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$113.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.00
|
|
|
IMPLT SCREW SET TI 08X17.5MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW SET TI 08X17.5MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREWS LOCKING 7MM
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$432.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$378.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
|
|
IMPLT SCREWS LOCKING 7MM
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$432.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Humana ChoiceCare |
$140.40
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.00
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$475.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$270.00
|
|
|
IMPLT SCREW SM.FRAG SET 3.5X28MM
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$191.25
|
| Rate for Payer: First Health Commercial |
$202.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$202.50
|
| Rate for Payer: GEHA Commercial |
$157.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$202.50
|
| Rate for Payer: Multiplan All |
$204.75
|
| Rate for Payer: OMNI Networks Commercial |
$157.50
|
| Rate for Payer: One Health Plan PPO/POS |
$202.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$213.75
|
| Rate for Payer: Three Rivers Provider Network All |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$209.25
|
| Rate for Payer: Zelis Auto |
$90.00
|
|
|
IMPLT SCREW SM.FRAG SET 3.5X28MM
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$191.25
|
| Rate for Payer: First Health Commercial |
$202.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$202.50
|
| Rate for Payer: GEHA Commercial |
$180.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$202.50
|
| Rate for Payer: Humana ChoiceCare |
$58.50
|
| Rate for Payer: Multiplan All |
$204.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$135.00
|
| Rate for Payer: OMNI Networks Commercial |
$157.50
|
| Rate for Payer: One Health Plan PPO/POS |
$202.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$213.75
|
| Rate for Payer: Three Rivers Provider Network All |
$168.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$209.25
|
| Rate for Payer: Zelis Auto |
$90.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$112.50
|
|
|
IMPLT SCREW SMOOTH PEG 2.0X16MM
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$540.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$472.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
|
|
IMPLT SCREW SMOOTH PEG 2.0X16MM
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Humana ChoiceCare |
$175.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$405.00
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$594.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$337.50
|
|
|
IMPLT SCREW SMOOTH PEG 2.0X18MM
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Humana ChoiceCare |
$175.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$405.00
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$594.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$337.50
|
|
