|
IMPLT SCREW 8.0X70MM
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$1,159.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$976.80
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna Commercial |
$1,037.85
|
| Rate for Payer: First Health Commercial |
$1,098.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,098.90
|
| Rate for Payer: GEHA Commercial |
$854.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,098.90
|
| Rate for Payer: Multiplan All |
$1,111.11
|
| Rate for Payer: OMNI Networks Commercial |
$854.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,098.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,159.95
|
| Rate for Payer: Three Rivers Provider Network All |
$915.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,135.53
|
| Rate for Payer: Zelis Auto |
$488.40
|
|
|
IMPLT SCREW 8.0X70MM
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.25 |
| Max. Negotiated Rate |
$1,159.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna Commercial |
$1,037.85
|
| Rate for Payer: First Health Commercial |
$1,098.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,098.90
|
| Rate for Payer: GEHA Commercial |
$976.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,098.90
|
| Rate for Payer: Humana ChoiceCare |
$317.46
|
| Rate for Payer: Multiplan All |
$1,111.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$732.60
|
| Rate for Payer: OMNI Networks Commercial |
$854.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,098.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,159.95
|
| Rate for Payer: Three Rivers Provider Network All |
$915.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,074.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$305.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,135.53
|
| Rate for Payer: Zelis Auto |
$488.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$610.50
|
|
|
IMPLT SCREW 8.0X75MM
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$1,159.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$976.80
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna Commercial |
$1,037.85
|
| Rate for Payer: First Health Commercial |
$1,098.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,098.90
|
| Rate for Payer: GEHA Commercial |
$854.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,098.90
|
| Rate for Payer: Multiplan All |
$1,111.11
|
| Rate for Payer: OMNI Networks Commercial |
$854.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,098.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,159.95
|
| Rate for Payer: Three Rivers Provider Network All |
$915.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,135.53
|
| Rate for Payer: Zelis Auto |
$488.40
|
|
|
IMPLT SCREW 8.0X75MM
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.25 |
| Max. Negotiated Rate |
$1,159.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna Commercial |
$1,037.85
|
| Rate for Payer: First Health Commercial |
$1,098.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,098.90
|
| Rate for Payer: GEHA Commercial |
$976.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,098.90
|
| Rate for Payer: Humana ChoiceCare |
$317.46
|
| Rate for Payer: Multiplan All |
$1,111.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$732.60
|
| Rate for Payer: OMNI Networks Commercial |
$854.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,098.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,159.95
|
| Rate for Payer: Three Rivers Provider Network All |
$915.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,074.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$305.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,135.53
|
| Rate for Payer: Zelis Auto |
$488.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$610.50
|
|
|
IMPLT SCREW 8.0X80MM
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.60 |
| Max. Negotiated Rate |
$1,020.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$859.20
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cigna Commercial |
$912.90
|
| Rate for Payer: First Health Commercial |
$966.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$966.60
|
| Rate for Payer: GEHA Commercial |
$751.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$966.60
|
| Rate for Payer: Multiplan All |
$977.34
|
| Rate for Payer: OMNI Networks Commercial |
$751.80
|
| Rate for Payer: One Health Plan PPO/POS |
$966.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,020.30
|
| Rate for Payer: Three Rivers Provider Network All |
$805.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$998.82
|
| Rate for Payer: Zelis Auto |
$429.60
|
|
|
IMPLT SCREW 8.0X80MM
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.50 |
| Max. Negotiated Rate |
$1,020.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cigna Commercial |
$912.90
|
| Rate for Payer: First Health Commercial |
$966.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$966.60
|
| Rate for Payer: GEHA Commercial |
$859.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$966.60
|
| Rate for Payer: Humana ChoiceCare |
$279.24
|
| Rate for Payer: Multiplan All |
$977.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.40
|
| Rate for Payer: OMNI Networks Commercial |
$751.80
|
| Rate for Payer: One Health Plan PPO/POS |
$966.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,020.30
|
| Rate for Payer: Three Rivers Provider Network All |
$805.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$945.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$268.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$998.82
|
| Rate for Payer: Zelis Auto |
$429.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$537.00
|
|
|
IMPLT SCREW #8.27.256.097.087
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.20
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$13.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
|
|
IMPLT SCREW #8.27.256.097.087
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$15.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Humana ChoiceCare |
$4.94
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.40
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.50
|
|
|
IMPLT SCREW ACETABULAR CANCELLOUS
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$300.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Humana ChoiceCare |
$97.76
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$225.60
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$330.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$188.00
|
|
|
IMPLT SCREW ACETABULAR CANCELLOUS
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.40 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.80
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
|
|
IMPLT SCREW ACU CRUC 2.7X14
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$190.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: Zelis Auto |
$108.80
|
|
|
IMPLT SCREW ACU CRUC 2.7X14
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$217.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Humana ChoiceCare |
$70.72
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$163.20
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$239.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$68.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: Zelis Auto |
$108.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$136.00
|
|
|
IMPLT SCREW ACUTRAK2 14MM
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$363.20 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$726.40
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$635.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
|
|
IMPLT SCREW ACUTRAK2 14MM
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.00 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$726.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Humana ChoiceCare |
$236.08
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.80
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$799.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$227.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.00
|
|
|
IMPLT SCREW ACUTRAK 22 MINI
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$363.20 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$726.40
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$635.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
|
|
IMPLT SCREW ACUTRAK 22 MINI
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.00 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$726.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Humana ChoiceCare |
$236.08
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.80
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$799.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$227.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.00
|
|
|
IMPLT SCREW ACUTRAK 22MM STANDARD
|
Facility
|
IP
|
$1,163.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.20 |
| Max. Negotiated Rate |
$1,104.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$930.40
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cigna Commercial |
$988.55
|
| Rate for Payer: First Health Commercial |
$1,046.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,046.70
|
| Rate for Payer: GEHA Commercial |
$814.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,046.70
|
| Rate for Payer: Multiplan All |
$1,058.33
|
| Rate for Payer: OMNI Networks Commercial |
$814.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,046.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,104.85
|
| Rate for Payer: Three Rivers Provider Network All |
$872.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,081.59
|
| Rate for Payer: Zelis Auto |
$465.20
|
|
|
IMPLT SCREW ACUTRAK 22MM STANDARD
|
Facility
|
OP
|
$1,163.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.75 |
| Max. Negotiated Rate |
$1,104.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$697.80
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cigna Commercial |
$988.55
|
| Rate for Payer: First Health Commercial |
$1,046.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,046.70
|
| Rate for Payer: GEHA Commercial |
$930.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,046.70
|
| Rate for Payer: Humana ChoiceCare |
$302.38
|
| Rate for Payer: Multiplan All |
$1,058.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$697.80
|
| Rate for Payer: OMNI Networks Commercial |
$814.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,046.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,104.85
|
| Rate for Payer: Three Rivers Provider Network All |
$872.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,023.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$290.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,081.59
|
| Rate for Payer: Zelis Auto |
$465.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$581.50
|
|
|
IMPLT SCREW ACUTRAK 24MM
|
Facility
|
IP
|
$2,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$829.20 |
| Max. Negotiated Rate |
$1,969.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cigna Commercial |
$1,762.05
|
| Rate for Payer: First Health Commercial |
$1,865.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,865.70
|
| Rate for Payer: GEHA Commercial |
$1,451.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,865.70
|
| Rate for Payer: Multiplan All |
$1,886.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,451.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,865.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,969.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,554.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,927.89
|
| Rate for Payer: Zelis Auto |
$829.20
|
|
|
IMPLT SCREW ACUTRAK 24MM
|
Facility
|
OP
|
$2,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.25 |
| Max. Negotiated Rate |
$1,969.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cigna Commercial |
$1,762.05
|
| Rate for Payer: First Health Commercial |
$1,865.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,865.70
|
| Rate for Payer: GEHA Commercial |
$1,658.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,865.70
|
| Rate for Payer: Humana ChoiceCare |
$538.98
|
| Rate for Payer: Multiplan All |
$1,886.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,243.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,451.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,865.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,969.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,554.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,824.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$518.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,927.89
|
| Rate for Payer: Zelis Auto |
$829.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,036.50
|
|
|
IMPLT SCREW ACUTRAK 28MM
|
Facility
|
OP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.25 |
| Max. Negotiated Rate |
$2,250.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cigna Commercial |
$2,013.65
|
| Rate for Payer: First Health Commercial |
$2,132.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,132.10
|
| Rate for Payer: GEHA Commercial |
$1,895.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,132.10
|
| Rate for Payer: Humana ChoiceCare |
$615.94
|
| Rate for Payer: Multiplan All |
$2,155.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,421.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,658.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,132.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,250.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,776.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,084.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$592.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,203.17
|
| Rate for Payer: Zelis Auto |
$947.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,184.50
|
|
|
IMPLT SCREW ACUTRAK 28MM
|
Facility
|
IP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.60 |
| Max. Negotiated Rate |
$2,250.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,895.20
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cigna Commercial |
$2,013.65
|
| Rate for Payer: First Health Commercial |
$2,132.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,132.10
|
| Rate for Payer: GEHA Commercial |
$1,658.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,132.10
|
| Rate for Payer: Multiplan All |
$2,155.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,658.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,132.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,250.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,776.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,203.17
|
| Rate for Payer: Zelis Auto |
$947.60
|
|
|
IMPLT SCREW ACUTRAK 2 MICRO 20MM
|
Facility
|
IP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.60 |
| Max. Negotiated Rate |
$2,250.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,895.20
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cigna Commercial |
$2,013.65
|
| Rate for Payer: First Health Commercial |
$2,132.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,132.10
|
| Rate for Payer: GEHA Commercial |
$1,658.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,132.10
|
| Rate for Payer: Multiplan All |
$2,155.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,658.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,132.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,250.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,776.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,203.17
|
| Rate for Payer: Zelis Auto |
$947.60
|
|
|
IMPLT SCREW ACUTRAK 2 MICRO 20MM
|
Facility
|
OP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.25 |
| Max. Negotiated Rate |
$2,250.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cash Price |
$1,421.40
|
| Rate for Payer: Cigna Commercial |
$2,013.65
|
| Rate for Payer: First Health Commercial |
$2,132.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,132.10
|
| Rate for Payer: GEHA Commercial |
$1,895.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,132.10
|
| Rate for Payer: Humana ChoiceCare |
$615.94
|
| Rate for Payer: Multiplan All |
$2,155.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,421.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,658.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,132.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,250.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,776.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,084.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$592.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,203.17
|
| Rate for Payer: Zelis Auto |
$947.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,184.50
|
|
|
IMPLT SCREW ACUTRAK 2 MICRO 9MM
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$363.20 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$726.40
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$635.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
|
