|
IMPLT SCREW COMPRESSION 2.5X13MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW COMPRESSION 2.5X14MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW COMPRESSION 2.5X14MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW COMPRESSION 2.5X15MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW COMPRESSION 2.5X15MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW COMPRESSION 2.5X22MM
|
Facility
|
IP
|
$1,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.20 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$978.40
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$856.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
|
|
IMPLT SCREW COMPRESSION 2.5X22MM
|
Facility
|
OP
|
$1,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.75 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$978.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Humana ChoiceCare |
$317.98
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$733.80
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,076.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$305.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$611.50
|
|
|
IMPLT SCREW COMPRESSION 2.5X23MM
|
Facility
|
IP
|
$1,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.20 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$978.40
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$856.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
|
|
IMPLT SCREW COMPRESSION 2.5X23MM
|
Facility
|
OP
|
$1,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.75 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$978.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Humana ChoiceCare |
$317.98
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$733.80
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,076.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$305.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$611.50
|
|
|
IMPLT SCREW COMPRESSION 2.5X24MM
|
Facility
|
OP
|
$1,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.75 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$978.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Humana ChoiceCare |
$317.98
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$733.80
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,076.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$305.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$611.50
|
|
|
IMPLT SCREW COMPRESSION 2.5X24MM
|
Facility
|
IP
|
$1,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.20 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$978.40
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$856.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
|
|
IMPLT SCREW COMPRESSION 2.5X30MM
|
Facility
|
OP
|
$1,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.75 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$978.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Humana ChoiceCare |
$317.98
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$733.80
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,076.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$305.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$611.50
|
|
|
IMPLT SCREW COMPRESSION 2.5X30MM
|
Facility
|
IP
|
$1,223.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.20 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$978.40
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$856.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
|
|
IMPLT SCREW COMPRESSION 4.0X40MM
|
Facility
|
OP
|
$2,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.00 |
| Max. Negotiated Rate |
$2,044.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,291.20
|
| Rate for Payer: Cash Price |
$1,291.20
|
| Rate for Payer: Cash Price |
$1,291.20
|
| Rate for Payer: Cigna Commercial |
$1,829.20
|
| Rate for Payer: First Health Commercial |
$1,936.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,936.80
|
| Rate for Payer: GEHA Commercial |
$1,721.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,936.80
|
| Rate for Payer: Humana ChoiceCare |
$559.52
|
| Rate for Payer: Multiplan All |
$1,958.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,291.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,506.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,936.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,044.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,614.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,893.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$538.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,001.36
|
| Rate for Payer: Zelis Auto |
$860.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,076.00
|
|
|
IMPLT SCREW COMPRESSION 4.0X40MM
|
Facility
|
IP
|
$2,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$860.80 |
| Max. Negotiated Rate |
$2,044.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,291.20
|
| Rate for Payer: Cash Price |
$1,291.20
|
| Rate for Payer: Cigna Commercial |
$1,829.20
|
| Rate for Payer: First Health Commercial |
$1,936.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,936.80
|
| Rate for Payer: GEHA Commercial |
$1,506.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,936.80
|
| Rate for Payer: Multiplan All |
$1,958.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,506.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,936.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,044.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,614.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,001.36
|
| Rate for Payer: Zelis Auto |
$860.80
|
|
|
IMPLT SCREW COMPRESSION 4.0X50MM
|
Facility
|
IP
|
$2,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$860.80 |
| Max. Negotiated Rate |
$2,044.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,291.20
|
| Rate for Payer: Cash Price |
$1,291.20
|
| Rate for Payer: Cigna Commercial |
$1,829.20
|
| Rate for Payer: First Health Commercial |
$1,936.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,936.80
|
| Rate for Payer: GEHA Commercial |
$1,506.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,936.80
|
| Rate for Payer: Multiplan All |
$1,958.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,506.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,936.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,044.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,614.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,001.36
|
| Rate for Payer: Zelis Auto |
$860.80
|
|
|
IMPLT SCREW COMPRESSION 4.0X50MM
|
Facility
|
OP
|
$2,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.00 |
| Max. Negotiated Rate |
$2,044.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,291.20
|
| Rate for Payer: Cash Price |
$1,291.20
|
| Rate for Payer: Cash Price |
$1,291.20
|
| Rate for Payer: Cigna Commercial |
$1,829.20
|
| Rate for Payer: First Health Commercial |
$1,936.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,936.80
|
| Rate for Payer: GEHA Commercial |
$1,721.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,936.80
|
| Rate for Payer: Humana ChoiceCare |
$559.52
|
| Rate for Payer: Multiplan All |
$1,958.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,291.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,506.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,936.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,044.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,614.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,893.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$538.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,001.36
|
| Rate for Payer: Zelis Auto |
$860.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,076.00
|
|
|
IMPLT SCREW COMPRESSION CANNULATED 3.2
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.80 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,385.60
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,212.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
|
|
IMPLT SCREW COMPRESSION CANNULATED 3.2
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.00 |
| Max. Negotiated Rate |
$1,645.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$1,472.20
|
| Rate for Payer: First Health Commercial |
$1,558.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,558.80
|
| Rate for Payer: GEHA Commercial |
$1,385.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,558.80
|
| Rate for Payer: Humana ChoiceCare |
$450.32
|
| Rate for Payer: Multiplan All |
$1,576.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,039.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,212.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,558.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,645.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,524.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$433.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,610.76
|
| Rate for Payer: Zelis Auto |
$692.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$866.00
|
|
|
IMPLT SCREW COMPRESSION T2 TIBIA SYSTEM
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.00 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cigna Commercial |
$769.25
|
| Rate for Payer: First Health Commercial |
$814.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$814.50
|
| Rate for Payer: GEHA Commercial |
$633.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$814.50
|
| Rate for Payer: Multiplan All |
$823.55
|
| Rate for Payer: OMNI Networks Commercial |
$633.50
|
| Rate for Payer: One Health Plan PPO/POS |
$814.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$859.75
|
| Rate for Payer: Three Rivers Provider Network All |
$678.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$841.65
|
| Rate for Payer: Zelis Auto |
$362.00
|
|
|
IMPLT SCREW COMPRESSION T2 TIBIA SYSTEM
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.25 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cigna Commercial |
$769.25
|
| Rate for Payer: First Health Commercial |
$814.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$814.50
|
| Rate for Payer: GEHA Commercial |
$724.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$814.50
|
| Rate for Payer: Humana ChoiceCare |
$235.30
|
| Rate for Payer: Multiplan All |
$823.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.00
|
| Rate for Payer: OMNI Networks Commercial |
$633.50
|
| Rate for Payer: One Health Plan PPO/POS |
$814.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$859.75
|
| Rate for Payer: Three Rivers Provider Network All |
$678.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$796.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$841.65
|
| Rate for Payer: Zelis Auto |
$362.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$452.50
|
|
|
IMPLT SCREW CONDYLE 05X55MM
|
Facility
|
OP
|
$1,041.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$260.25 |
| Max. Negotiated Rate |
$988.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna Commercial |
$884.85
|
| Rate for Payer: First Health Commercial |
$936.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$936.90
|
| Rate for Payer: GEHA Commercial |
$832.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$936.90
|
| Rate for Payer: Humana ChoiceCare |
$270.66
|
| Rate for Payer: Multiplan All |
$947.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$624.60
|
| Rate for Payer: OMNI Networks Commercial |
$728.70
|
| Rate for Payer: One Health Plan PPO/POS |
$936.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$988.95
|
| Rate for Payer: Three Rivers Provider Network All |
$780.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$916.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$260.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$968.13
|
| Rate for Payer: Zelis Auto |
$416.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$520.50
|
|
|
IMPLT SCREW CONDYLE 05X55MM
|
Facility
|
IP
|
$1,041.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.40 |
| Max. Negotiated Rate |
$988.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$832.80
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna Commercial |
$884.85
|
| Rate for Payer: First Health Commercial |
$936.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$936.90
|
| Rate for Payer: GEHA Commercial |
$728.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$936.90
|
| Rate for Payer: Multiplan All |
$947.31
|
| Rate for Payer: OMNI Networks Commercial |
$728.70
|
| Rate for Payer: One Health Plan PPO/POS |
$936.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$988.95
|
| Rate for Payer: Three Rivers Provider Network All |
$780.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$968.13
|
| Rate for Payer: Zelis Auto |
$416.40
|
|
|
IMPLT SCREW CONDYLE 05X60MM
|
Facility
|
IP
|
$1,041.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.40 |
| Max. Negotiated Rate |
$988.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$832.80
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna Commercial |
$884.85
|
| Rate for Payer: First Health Commercial |
$936.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$936.90
|
| Rate for Payer: GEHA Commercial |
$728.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$936.90
|
| Rate for Payer: Multiplan All |
$947.31
|
| Rate for Payer: OMNI Networks Commercial |
$728.70
|
| Rate for Payer: One Health Plan PPO/POS |
$936.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$988.95
|
| Rate for Payer: Three Rivers Provider Network All |
$780.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$968.13
|
| Rate for Payer: Zelis Auto |
$416.40
|
|
|
IMPLT SCREW CONDYLE 05X60MM
|
Facility
|
OP
|
$1,041.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$260.25 |
| Max. Negotiated Rate |
$988.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna Commercial |
$884.85
|
| Rate for Payer: First Health Commercial |
$936.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$936.90
|
| Rate for Payer: GEHA Commercial |
$832.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$936.90
|
| Rate for Payer: Humana ChoiceCare |
$270.66
|
| Rate for Payer: Multiplan All |
$947.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$624.60
|
| Rate for Payer: OMNI Networks Commercial |
$728.70
|
| Rate for Payer: One Health Plan PPO/POS |
$936.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$988.95
|
| Rate for Payer: Three Rivers Provider Network All |
$780.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$916.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$260.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$968.13
|
| Rate for Payer: Zelis Auto |
$416.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$520.50
|
|
