|
IMPLT SCREW BONE 4.0X48MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW BONE 4.0X48MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW BONE 4.0X50MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW BONE 4.0X50MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW BONE 8.0MM MICRO
|
Facility
|
IP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000488
|
|
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 BONE 8.0MM MICRO
|
Facility
|
OP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000488
|
|
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 BONE 8MM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$331.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
|
|
IMPLT SCREW BONE 8MM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$379.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Humana ChoiceCare |
$123.24
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$284.40
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$417.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$237.00
|
|
|
IMPLT SCREW BONE CANCELLOUS 6.5X20MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000489
|
|
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 BONE CANCELLOUS 6.5X20MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000489
|
|
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 BONE CANCELLOUS 6.5X40MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001369
|
|
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 BONE CANCELLOUS 6.5X40MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001369
|
|
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 BONE MINI 20MM
|
Facility
|
OP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000490
|
|
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 BONE MINI 20MM
|
Facility
|
IP
|
$2,369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000490
|
|
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 BONE PIN CROSS 2.3X20MM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$379.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Humana ChoiceCare |
$123.24
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$284.40
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$417.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$237.00
|
|
|
IMPLT SCREW BONE PIN CROSS 2.3X20MM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$331.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
|
|
IMPLT SCREW BONE PROFILE LOW 5.5X30MM
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.60 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$475.20
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$504.90
|
| Rate for Payer: First Health Commercial |
$534.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$534.60
|
| Rate for Payer: GEHA Commercial |
$415.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$534.60
|
| Rate for Payer: Multiplan All |
$540.54
|
| Rate for Payer: OMNI Networks Commercial |
$415.80
|
| Rate for Payer: One Health Plan PPO/POS |
$534.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$564.30
|
| Rate for Payer: Three Rivers Provider Network All |
$445.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$552.42
|
| Rate for Payer: Zelis Auto |
$237.60
|
|
|
IMPLT SCREW BONE PROFILE LOW 5.5X30MM
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$504.90
|
| Rate for Payer: First Health Commercial |
$534.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$534.60
|
| Rate for Payer: GEHA Commercial |
$475.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$534.60
|
| Rate for Payer: Humana ChoiceCare |
$154.44
|
| Rate for Payer: Multiplan All |
$540.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$356.40
|
| Rate for Payer: OMNI Networks Commercial |
$415.80
|
| Rate for Payer: One Health Plan PPO/POS |
$534.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$564.30
|
| Rate for Payer: Three Rivers Provider Network All |
$445.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$522.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$552.42
|
| Rate for Payer: Zelis Auto |
$237.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$297.00
|
|
|
IMPLT SCREW BONE STANDARD 26MM
|
Facility
|
IP
|
$2,369.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006107
|
|
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 BONE STANDARD 26MM
|
Facility
|
OP
|
$2,369.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006107
|
|
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 BONE T10 3.5MM/44MM
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$470.40
|
| 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 |
$411.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Multiplan All |
$535.08
|
| 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: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
|
|
IMPLT SCREW BONE T10 3.5MM/44MM
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006325
|
|
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
|
|
|
IMPLT SCREW BONE T10 3.5MM/65MM
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003230
|
|
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
|
|
|
IMPLT SCREW BONE T10 3.5MM/65MM
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$470.40
|
| 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 |
$411.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Multiplan All |
$535.08
|
| 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: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
|
|
IMPLT SCREW BONE T10 3.5MM/L26MM
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006316
|
|
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
|
|
