|
IMPLT SCREW 3.5 CORTEX THREADED FULLY
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.25 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$167.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Humana ChoiceCare |
$54.34
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$125.40
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$183.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$52.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.50
|
|
|
IMPLT SCREW 3.5 CORTEX THREADED FULLY
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.20
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$146.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
|
|
IMPLT SCREW 3.5 CORTICAL F/T 24MM
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$122.40
|
| Rate for Payer: First Health Commercial |
$129.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$129.60
|
| Rate for Payer: GEHA Commercial |
$115.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$129.60
|
| Rate for Payer: Humana ChoiceCare |
$37.44
|
| Rate for Payer: Multiplan All |
$131.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$86.40
|
| Rate for Payer: OMNI Networks Commercial |
$100.80
|
| Rate for Payer: One Health Plan PPO/POS |
$129.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$136.80
|
| Rate for Payer: Three Rivers Provider Network All |
$108.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$126.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$133.92
|
| Rate for Payer: Zelis Auto |
$57.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$72.00
|
|
|
IMPLT SCREW 3.5 CORTICAL F/T 24MM
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$122.40
|
| Rate for Payer: First Health Commercial |
$129.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$129.60
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$129.60
|
| Rate for Payer: Multiplan All |
$131.04
|
| Rate for Payer: OMNI Networks Commercial |
$100.80
|
| Rate for Payer: One Health Plan PPO/POS |
$129.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$136.80
|
| Rate for Payer: Three Rivers Provider Network All |
$108.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$133.92
|
| Rate for Payer: Zelis Auto |
$57.60
|
|
|
IMPLT SCREW 3.5 LOCKING 18MM
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$561.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Humana ChoiceCare |
$182.52
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$421.20
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$617.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$351.00
|
|
|
IMPLT SCREW 3.5 LOCKING 18MM
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.60
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$491.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
|
|
IMPLT SCREW 3.5MM CANNULATED
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.60 |
| Max. Negotiated Rate |
$1,105.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$931.20
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$814.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: Zelis Auto |
$465.60
|
|
|
IMPLT SCREW 3.5MM CANNULATED
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$1,105.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$931.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Humana ChoiceCare |
$302.64
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$698.40
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,024.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$291.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: Zelis Auto |
$465.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$582.00
|
|
|
IMPLT SCREW 3.5MM CORTEX
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.40 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$216.80
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$230.35
|
| Rate for Payer: First Health Commercial |
$243.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.90
|
| Rate for Payer: GEHA Commercial |
$189.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.90
|
| Rate for Payer: Multiplan All |
$246.61
|
| Rate for Payer: OMNI Networks Commercial |
$189.70
|
| Rate for Payer: One Health Plan PPO/POS |
$243.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$257.45
|
| Rate for Payer: Three Rivers Provider Network All |
$203.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.03
|
| Rate for Payer: Zelis Auto |
$108.40
|
|
|
IMPLT SCREW 3.5MM CORTEX
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.40 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$216.80
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$230.35
|
| Rate for Payer: First Health Commercial |
$243.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.90
|
| Rate for Payer: GEHA Commercial |
$189.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.90
|
| Rate for Payer: Multiplan All |
$246.61
|
| Rate for Payer: OMNI Networks Commercial |
$189.70
|
| Rate for Payer: One Health Plan PPO/POS |
$243.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$257.45
|
| Rate for Payer: Three Rivers Provider Network All |
$203.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.03
|
| Rate for Payer: Zelis Auto |
$108.40
|
|
|
IMPLT SCREW 3.5MM CORTEX
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.75 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$230.35
|
| Rate for Payer: First Health Commercial |
$243.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.90
|
| Rate for Payer: GEHA Commercial |
$216.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.90
|
| Rate for Payer: Humana ChoiceCare |
$70.46
|
| Rate for Payer: Multiplan All |
$246.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$162.60
|
| Rate for Payer: OMNI Networks Commercial |
$189.70
|
| Rate for Payer: One Health Plan PPO/POS |
$243.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$257.45
|
| Rate for Payer: Three Rivers Provider Network All |
$203.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$238.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.03
|
| Rate for Payer: Zelis Auto |
$108.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$135.50
|
|
|
IMPLT SCREW 3.5MM CORTEX
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.75 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$230.35
|
| Rate for Payer: First Health Commercial |
$243.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.90
|
| Rate for Payer: GEHA Commercial |
$216.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.90
|
| Rate for Payer: Humana ChoiceCare |
$70.46
|
| Rate for Payer: Multiplan All |
$246.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$162.60
|
| Rate for Payer: OMNI Networks Commercial |
$189.70
|
| Rate for Payer: One Health Plan PPO/POS |
$243.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$257.45
|
| Rate for Payer: Three Rivers Provider Network All |
$203.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$238.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.03
|
| Rate for Payer: Zelis Auto |
$108.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$135.50
|
|
|
IMPLT SCREW 3.5MM CORTEX 12MM
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.20
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.00
|
|
|
IMPLT SCREW 3.5MM CORTEX 12MM
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
|
|
IMPLT SCREW 3.5 MM CORTICALF/T 12MM
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$122.40
|
| Rate for Payer: First Health Commercial |
$129.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$129.60
|
| Rate for Payer: GEHA Commercial |
$115.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$129.60
|
| Rate for Payer: Humana ChoiceCare |
$37.44
|
| Rate for Payer: Multiplan All |
$131.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$86.40
|
| Rate for Payer: OMNI Networks Commercial |
$100.80
|
| Rate for Payer: One Health Plan PPO/POS |
$129.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$136.80
|
| Rate for Payer: Three Rivers Provider Network All |
$108.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$126.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$133.92
|
| Rate for Payer: Zelis Auto |
$57.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$72.00
|
|
|
IMPLT SCREW 3.5 MM CORTICALF/T 12MM
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$122.40
|
| Rate for Payer: First Health Commercial |
$129.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$129.60
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$129.60
|
| Rate for Payer: Multiplan All |
$131.04
|
| Rate for Payer: OMNI Networks Commercial |
$100.80
|
| Rate for Payer: One Health Plan PPO/POS |
$129.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$136.80
|
| Rate for Payer: Three Rivers Provider Network All |
$108.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$133.92
|
| Rate for Payer: Zelis Auto |
$57.60
|
|
|
IMPLT SCREW 3.5MM FULL THREADED
|
Facility
|
IP
|
$1,216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.40 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$972.80
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: First Health Commercial |
$1,094.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,094.40
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,094.40
|
| Rate for Payer: Multiplan All |
$1,106.56
|
| Rate for Payer: OMNI Networks Commercial |
$851.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,094.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,155.20
|
| Rate for Payer: Three Rivers Provider Network All |
$912.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,130.88
|
| Rate for Payer: Zelis Auto |
$486.40
|
|
|
IMPLT SCREW 3.5MM FULL THREADED
|
Facility
|
OP
|
$1,216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: First Health Commercial |
$1,094.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,094.40
|
| Rate for Payer: GEHA Commercial |
$972.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,094.40
|
| Rate for Payer: Humana ChoiceCare |
$316.16
|
| Rate for Payer: Multiplan All |
$1,106.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$729.60
|
| Rate for Payer: OMNI Networks Commercial |
$851.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,094.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,155.20
|
| Rate for Payer: Three Rivers Provider Network All |
$912.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,070.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,130.88
|
| Rate for Payer: Zelis Auto |
$486.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$608.00
|
|
|
IMPLT SCREW 3.5X10MM
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
|
|
IMPLT SCREW 3.5X10MM
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$192.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Humana ChoiceCare |
$62.40
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.00
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$211.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.00
|
|
|
IMPLT SCREW 3.5X 12MM LOCKING
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$192.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Humana ChoiceCare |
$62.40
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.00
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$211.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.00
|
|
|
IMPLT SCREW 3.5X 12MM LOCKING
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
|
|
IMPLT SCREW 3.5X14MM
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.40 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$608.80
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$532.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
|
|
IMPLT SCREW 3.5X14MM
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.25 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$608.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Humana ChoiceCare |
$197.86
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$456.60
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$669.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$190.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$380.50
|
|
|
IMPLT SCREW 3.5X14MM
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000692
|
|
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
|
|
