|
IMPLT SCREW THRED 5.0MMX14MM
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$531.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$447.20
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$391.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| Rate for Payer: Multiplan All |
$508.69
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$531.05
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$519.87
|
| Rate for Payer: Zelis Auto |
$223.60
|
|
|
IMPLT SCREW THRED 5.0MMX14MM
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$531.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$447.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| Rate for Payer: Humana ChoiceCare |
$145.34
|
| Rate for Payer: Multiplan All |
$508.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$335.40
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$531.05
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$519.87
|
| Rate for Payer: Zelis Auto |
$223.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.50
|
|
|
IMPLT SCREW THRED 5.0MMX28MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THRED 5.0MMX28MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THRED 5.0MMX30MM
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.20 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$462.40
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$491.30
|
| Rate for Payer: First Health Commercial |
$520.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$520.20
|
| Rate for Payer: GEHA Commercial |
$404.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$520.20
|
| Rate for Payer: Multiplan All |
$525.98
|
| Rate for Payer: OMNI Networks Commercial |
$404.60
|
| Rate for Payer: One Health Plan PPO/POS |
$520.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$549.10
|
| Rate for Payer: Three Rivers Provider Network All |
$433.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$537.54
|
| Rate for Payer: Zelis Auto |
$231.20
|
|
|
IMPLT SCREW THRED 5.0MMX30MM
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$491.30
|
| Rate for Payer: First Health Commercial |
$520.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$520.20
|
| Rate for Payer: GEHA Commercial |
$462.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$520.20
|
| Rate for Payer: Humana ChoiceCare |
$150.28
|
| Rate for Payer: Multiplan All |
$525.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$346.80
|
| Rate for Payer: OMNI Networks Commercial |
$404.60
|
| Rate for Payer: One Health Plan PPO/POS |
$520.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$549.10
|
| Rate for Payer: Three Rivers Provider Network All |
$433.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$508.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$144.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$537.54
|
| Rate for Payer: Zelis Auto |
$231.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$289.00
|
|
|
IMPLT SCREW THRED 5.0MMX32MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THRED 5.0MMX32MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THRED 5.0MMX36MM
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$491.30
|
| Rate for Payer: First Health Commercial |
$520.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$520.20
|
| Rate for Payer: GEHA Commercial |
$462.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$520.20
|
| Rate for Payer: Humana ChoiceCare |
$150.28
|
| Rate for Payer: Multiplan All |
$525.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$346.80
|
| Rate for Payer: OMNI Networks Commercial |
$404.60
|
| Rate for Payer: One Health Plan PPO/POS |
$520.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$549.10
|
| Rate for Payer: Three Rivers Provider Network All |
$433.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$508.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$144.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$537.54
|
| Rate for Payer: Zelis Auto |
$231.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$289.00
|
|
|
IMPLT SCREW THRED 5.0MMX36MM
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.20 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$462.40
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$491.30
|
| Rate for Payer: First Health Commercial |
$520.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$520.20
|
| Rate for Payer: GEHA Commercial |
$404.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$520.20
|
| Rate for Payer: Multiplan All |
$525.98
|
| Rate for Payer: OMNI Networks Commercial |
$404.60
|
| Rate for Payer: One Health Plan PPO/POS |
$520.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$549.10
|
| Rate for Payer: Three Rivers Provider Network All |
$433.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$537.54
|
| Rate for Payer: Zelis Auto |
$231.20
|
|
|
IMPLT SCREW TI ANCHOR 3.0MM SZ 2
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.40 |
| Max. Negotiated Rate |
$1,668.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,404.80
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cigna Commercial |
$1,492.60
|
| Rate for Payer: First Health Commercial |
$1,580.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,580.40
|
| Rate for Payer: GEHA Commercial |
$1,229.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,580.40
|
| Rate for Payer: Multiplan All |
$1,597.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,229.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,580.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,668.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,317.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,633.08
|
| Rate for Payer: Zelis Auto |
$702.40
|
|
|
IMPLT SCREW TI ANCHOR 3.0MM SZ 2
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.00 |
| Max. Negotiated Rate |
$1,668.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cigna Commercial |
$1,492.60
|
| Rate for Payer: First Health Commercial |
$1,580.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,580.40
|
| Rate for Payer: GEHA Commercial |
$1,404.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,580.40
|
| Rate for Payer: Humana ChoiceCare |
$456.56
|
| Rate for Payer: Multiplan All |
$1,597.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,053.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,229.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,580.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,668.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,317.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,545.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$439.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,633.08
|
| Rate for Payer: Zelis Auto |
$702.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$878.00
|
|
|
IMPLT SCREW TI LAG 10.5X70MM
|
Facility
|
IP
|
$1,874.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$749.60 |
| Max. Negotiated Rate |
$1,780.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,499.20
|
| Rate for Payer: Cash Price |
$1,124.40
|
| Rate for Payer: Cash Price |
$1,124.40
|
| Rate for Payer: Cigna Commercial |
$1,592.90
|
| Rate for Payer: First Health Commercial |
$1,686.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,686.60
|
| Rate for Payer: GEHA Commercial |
$1,311.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,686.60
|
| Rate for Payer: Multiplan All |
$1,705.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,311.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,686.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,780.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,405.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,742.82
|
| Rate for Payer: Zelis Auto |
$749.60
|
|
|
IMPLT SCREW TI LAG 10.5X70MM
|
Facility
|
OP
|
$1,874.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.50 |
| Max. Negotiated Rate |
$1,780.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,124.40
|
| Rate for Payer: Cash Price |
$1,124.40
|
| Rate for Payer: Cash Price |
$1,124.40
|
| Rate for Payer: Cigna Commercial |
$1,592.90
|
| Rate for Payer: First Health Commercial |
$1,686.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,686.60
|
| Rate for Payer: GEHA Commercial |
$1,499.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,686.60
|
| Rate for Payer: Humana ChoiceCare |
$487.24
|
| Rate for Payer: Multiplan All |
$1,705.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,124.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,311.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,686.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,780.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,405.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,649.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$468.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,742.82
|
| Rate for Payer: Zelis Auto |
$749.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$937.00
|
|
|
IMPLT SCREW TI LAG 10.5X80MM
|
Facility
|
IP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.20 |
| Max. Negotiated Rate |
$2,021.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,702.40
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: First Health Commercial |
$1,915.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,915.20
|
| Rate for Payer: GEHA Commercial |
$1,489.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,915.20
|
| Rate for Payer: Multiplan All |
$1,936.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,489.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,915.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,021.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,596.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,979.04
|
| Rate for Payer: Zelis Auto |
$851.20
|
|
|
IMPLT SCREW TI LAG 10.5X80MM
|
Facility
|
OP
|
$2,128.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$2,021.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: First Health Commercial |
$1,915.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,915.20
|
| Rate for Payer: GEHA Commercial |
$1,702.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,915.20
|
| Rate for Payer: Humana ChoiceCare |
$553.28
|
| Rate for Payer: Multiplan All |
$1,936.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,276.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,489.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,915.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,021.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,596.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,872.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$532.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,979.04
|
| Rate for Payer: Zelis Auto |
$851.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,064.00
|
|
|
IMPLT SCREW TITANIUM 6.5X100MM
|
Facility
|
IP
|
$1,194.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.60 |
| Max. Negotiated Rate |
$1,134.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$955.20
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cigna Commercial |
$1,014.90
|
| Rate for Payer: First Health Commercial |
$1,074.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,074.60
|
| Rate for Payer: GEHA Commercial |
$835.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,074.60
|
| Rate for Payer: Multiplan All |
$1,086.54
|
| Rate for Payer: OMNI Networks Commercial |
$835.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,074.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,134.30
|
| Rate for Payer: Three Rivers Provider Network All |
$895.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,110.42
|
| Rate for Payer: Zelis Auto |
$477.60
|
|
|
IMPLT SCREW TITANIUM 6.5X100MM
|
Facility
|
OP
|
$1,194.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.50 |
| Max. Negotiated Rate |
$1,134.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$716.40
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cigna Commercial |
$1,014.90
|
| Rate for Payer: First Health Commercial |
$1,074.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,074.60
|
| Rate for Payer: GEHA Commercial |
$955.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,074.60
|
| Rate for Payer: Humana ChoiceCare |
$310.44
|
| Rate for Payer: Multiplan All |
$1,086.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$716.40
|
| Rate for Payer: OMNI Networks Commercial |
$835.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,074.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,134.30
|
| Rate for Payer: Three Rivers Provider Network All |
$895.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,050.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$298.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,110.42
|
| Rate for Payer: Zelis Auto |
$477.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$597.00
|
|
|
IMPLT SCREW TORX CANCELLOUS 6.5X35MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$121.42
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$280.20
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$410.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.50
|
|
|
IMPLT SCREW TORX CANCELLOUS 6.5X35MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.60
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
|
|
IMPLT SCREW TWINFIX 3.2X25MM
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.50 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$1,121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Humana ChoiceCare |
$364.52
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$841.20
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,233.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$350.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$701.00
|
|
|
IMPLT SCREW TWINFIX 3.2X25MM
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.80 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,121.60
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$981.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
|
|
IMPLT SCREW TWINFIX 3.2X26MM
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.00 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,385.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Humana ChoiceCare |
$450.32
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,039.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,524.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$433.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$866.00
|
|
|
IMPLT SCREW TWINFIX 3.2X26MM
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.80 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,385.60
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,212.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
|
|
IMPLT SCREW VARIAX 2.7 X 8MM
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$470.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Humana ChoiceCare |
$152.88
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$352.80
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$517.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$294.00
|
|
