|
IMPLT SCREW CORTEX TITANIUM 2.4X28MM
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$680.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$429.60
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cigna Commercial |
$608.60
|
| Rate for Payer: First Health Commercial |
$644.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$644.40
|
| Rate for Payer: GEHA Commercial |
$572.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$644.40
|
| Rate for Payer: Humana ChoiceCare |
$186.16
|
| Rate for Payer: Multiplan All |
$651.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$429.60
|
| Rate for Payer: OMNI Networks Commercial |
$501.20
|
| Rate for Payer: One Health Plan PPO/POS |
$644.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$680.20
|
| Rate for Payer: Three Rivers Provider Network All |
$537.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$630.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$179.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$665.88
|
| Rate for Payer: Zelis Auto |
$286.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$358.00
|
|
|
IMPLT SCREW CORTEX TITANIUM 2.4X28MM
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.40 |
| Max. Negotiated Rate |
$680.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$572.80
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cigna Commercial |
$608.60
|
| Rate for Payer: First Health Commercial |
$644.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$644.40
|
| Rate for Payer: GEHA Commercial |
$501.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$644.40
|
| Rate for Payer: Multiplan All |
$651.56
|
| Rate for Payer: OMNI Networks Commercial |
$501.20
|
| Rate for Payer: One Health Plan PPO/POS |
$644.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$680.20
|
| Rate for Payer: Three Rivers Provider Network All |
$537.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$665.88
|
| Rate for Payer: Zelis Auto |
$286.40
|
|
|
IMPLT SCREW CORTEX TITANIUM 2.4X34MM
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$339.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Humana ChoiceCare |
$110.24
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.40
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$212.00
|
|
|
IMPLT SCREW CORTEX TITANIUM 2.4X34MM
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.60 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$339.20
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: Zelis Auto |
$169.60
|
|
|
IMPLT SCREW CORTEX TITANIUM 2.4X38MM
|
Facility
|
OP
|
$1,976.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$1,877.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,185.60
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Cigna Commercial |
$1,679.60
|
| Rate for Payer: First Health Commercial |
$1,778.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,778.40
|
| Rate for Payer: GEHA Commercial |
$1,580.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,778.40
|
| Rate for Payer: Humana ChoiceCare |
$513.76
|
| Rate for Payer: Multiplan All |
$1,798.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,185.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,383.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,778.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,877.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,482.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,738.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$494.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,837.68
|
| Rate for Payer: Zelis Auto |
$790.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$988.00
|
|
|
IMPLT SCREW CORTEX TITANIUM 2.4X38MM
|
Facility
|
IP
|
$1,976.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.40 |
| Max. Negotiated Rate |
$1,877.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,580.80
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Cigna Commercial |
$1,679.60
|
| Rate for Payer: First Health Commercial |
$1,778.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,778.40
|
| Rate for Payer: GEHA Commercial |
$1,383.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,778.40
|
| Rate for Payer: Multiplan All |
$1,798.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,383.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,778.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,877.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,482.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,837.68
|
| Rate for Payer: Zelis Auto |
$790.40
|
|
|
IMPLT SCREW CORTICAL
|
Facility
|
OP
|
$1,682.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.50 |
| Max. Negotiated Rate |
$1,597.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,009.20
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cigna Commercial |
$1,429.70
|
| Rate for Payer: First Health Commercial |
$1,513.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,513.80
|
| Rate for Payer: GEHA Commercial |
$1,345.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,513.80
|
| Rate for Payer: Humana ChoiceCare |
$437.32
|
| Rate for Payer: Multiplan All |
$1,530.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,009.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,177.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,513.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,597.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,261.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,480.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$420.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,564.26
|
| Rate for Payer: Zelis Auto |
$672.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$841.00
|
|
|
IMPLT SCREW CORTICAL
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.80 |
| Max. Negotiated Rate |
$1,597.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,345.60
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cigna Commercial |
$1,429.70
|
| Rate for Payer: First Health Commercial |
$1,513.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,513.80
|
| Rate for Payer: GEHA Commercial |
$1,177.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,513.80
|
| Rate for Payer: Multiplan All |
$1,530.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,177.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,513.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,597.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,261.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,564.26
|
| Rate for Payer: Zelis Auto |
$672.80
|
|
|
IMPLT SCREW CORTICAL 14MM 482701401
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.00
|
| Rate for Payer: GEHA Commercial |
$152.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.00
|
| Rate for Payer: Humana ChoiceCare |
$49.40
|
| Rate for Payer: Multiplan All |
$172.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.00
|
| Rate for Payer: OMNI Networks Commercial |
$133.00
|
| Rate for Payer: One Health Plan PPO/POS |
$171.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$180.50
|
| Rate for Payer: Three Rivers Provider Network All |
$142.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$167.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$47.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$176.70
|
| Rate for Payer: Zelis Auto |
$76.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$95.00
|
|
|
IMPLT SCREW CORTICAL 14MM 482701401
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.00
|
| Rate for Payer: GEHA Commercial |
$133.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.00
|
| Rate for Payer: Multiplan All |
$172.90
|
| Rate for Payer: OMNI Networks Commercial |
$133.00
|
| Rate for Payer: One Health Plan PPO/POS |
$171.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$180.50
|
| Rate for Payer: Three Rivers Provider Network All |
$142.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$176.70
|
| Rate for Payer: Zelis Auto |
$76.00
|
|
|
IMPLT SCREW CORTICAL 2.7 X 10MM
|
Facility
|
OP
|
$1,314.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.50 |
| Max. Negotiated Rate |
$1,248.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna Commercial |
$1,116.90
|
| Rate for Payer: First Health Commercial |
$1,182.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,182.60
|
| Rate for Payer: GEHA Commercial |
$1,051.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,182.60
|
| Rate for Payer: Humana ChoiceCare |
$341.64
|
| Rate for Payer: Multiplan All |
$1,195.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$788.40
|
| Rate for Payer: OMNI Networks Commercial |
$919.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,182.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,248.30
|
| Rate for Payer: Three Rivers Provider Network All |
$985.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,156.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$328.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,222.02
|
| Rate for Payer: Zelis Auto |
$525.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$657.00
|
|
|
IMPLT SCREW CORTICAL 2.7 X 10MM
|
Facility
|
IP
|
$1,314.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.60 |
| Max. Negotiated Rate |
$1,248.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,051.20
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna Commercial |
$1,116.90
|
| Rate for Payer: First Health Commercial |
$1,182.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,182.60
|
| Rate for Payer: GEHA Commercial |
$919.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,182.60
|
| Rate for Payer: Multiplan All |
$1,195.74
|
| Rate for Payer: OMNI Networks Commercial |
$919.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,182.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,248.30
|
| Rate for Payer: Three Rivers Provider Network All |
$985.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,222.02
|
| Rate for Payer: Zelis Auto |
$525.60
|
|
|
IMPLT SCREW CORTICAL 2.7 X 12MM
|
Facility
|
OP
|
$1,314.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.50 |
| Max. Negotiated Rate |
$1,248.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna Commercial |
$1,116.90
|
| Rate for Payer: First Health Commercial |
$1,182.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,182.60
|
| Rate for Payer: GEHA Commercial |
$1,051.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,182.60
|
| Rate for Payer: Humana ChoiceCare |
$341.64
|
| Rate for Payer: Multiplan All |
$1,195.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$788.40
|
| Rate for Payer: OMNI Networks Commercial |
$919.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,182.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,248.30
|
| Rate for Payer: Three Rivers Provider Network All |
$985.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,156.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$328.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,222.02
|
| Rate for Payer: Zelis Auto |
$525.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$657.00
|
|
|
IMPLT SCREW CORTICAL 2.7 X 12MM
|
Facility
|
IP
|
$1,314.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.60 |
| Max. Negotiated Rate |
$1,248.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,051.20
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna Commercial |
$1,116.90
|
| Rate for Payer: First Health Commercial |
$1,182.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,182.60
|
| Rate for Payer: GEHA Commercial |
$919.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,182.60
|
| Rate for Payer: Multiplan All |
$1,195.74
|
| Rate for Payer: OMNI Networks Commercial |
$919.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,182.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,248.30
|
| Rate for Payer: Three Rivers Provider Network All |
$985.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,222.02
|
| Rate for Payer: Zelis Auto |
$525.60
|
|
|
IMPLT SCREW CORTICAL 2.7X12MM
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$49.92
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.20
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.00
|
|
|
IMPLT SCREW CORTICAL 2.7X12MM
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
|
|
IMPLT SCREW CORTICAL 2.7 X 14MM
|
Facility
|
OP
|
$1,314.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.50 |
| Max. Negotiated Rate |
$1,248.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna Commercial |
$1,116.90
|
| Rate for Payer: First Health Commercial |
$1,182.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,182.60
|
| Rate for Payer: GEHA Commercial |
$1,051.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,182.60
|
| Rate for Payer: Humana ChoiceCare |
$341.64
|
| Rate for Payer: Multiplan All |
$1,195.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$788.40
|
| Rate for Payer: OMNI Networks Commercial |
$919.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,182.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,248.30
|
| Rate for Payer: Three Rivers Provider Network All |
$985.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,156.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$328.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,222.02
|
| Rate for Payer: Zelis Auto |
$525.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$657.00
|
|
|
IMPLT SCREW CORTICAL 2.7 X 14MM
|
Facility
|
IP
|
$1,314.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.60 |
| Max. Negotiated Rate |
$1,248.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,051.20
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna Commercial |
$1,116.90
|
| Rate for Payer: First Health Commercial |
$1,182.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,182.60
|
| Rate for Payer: GEHA Commercial |
$919.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,182.60
|
| Rate for Payer: Multiplan All |
$1,195.74
|
| Rate for Payer: OMNI Networks Commercial |
$919.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,182.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,248.30
|
| Rate for Payer: Three Rivers Provider Network All |
$985.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,222.02
|
| Rate for Payer: Zelis Auto |
$525.60
|
|
|
IMPLT SCREW CORTICAL 2.7X14MM
|
Facility
|
OP
|
$389.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$369.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cigna Commercial |
$330.82
|
| Rate for Payer: First Health Commercial |
$350.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$350.28
|
| Rate for Payer: GEHA Commercial |
$311.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$350.28
|
| Rate for Payer: Humana ChoiceCare |
$101.19
|
| Rate for Payer: Multiplan All |
$354.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$233.52
|
| Rate for Payer: OMNI Networks Commercial |
$272.44
|
| Rate for Payer: One Health Plan PPO/POS |
$350.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.74
|
| Rate for Payer: Three Rivers Provider Network All |
$291.90
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$342.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.96
|
| Rate for Payer: Zelis Auto |
$155.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$194.60
|
|
|
IMPLT SCREW CORTICAL 2.7X14MM
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$348.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$261.60
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$383.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$109.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$218.00
|
|
|
IMPLT SCREW CORTICAL 2.7X14MM
|
Facility
|
IP
|
$389.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$369.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$311.36
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cigna Commercial |
$330.82
|
| Rate for Payer: First Health Commercial |
$350.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$350.28
|
| Rate for Payer: GEHA Commercial |
$272.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$350.28
|
| Rate for Payer: Multiplan All |
$354.17
|
| Rate for Payer: OMNI Networks Commercial |
$272.44
|
| Rate for Payer: One Health Plan PPO/POS |
$350.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.74
|
| Rate for Payer: Three Rivers Provider Network All |
$291.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.96
|
| Rate for Payer: Zelis Auto |
$155.68
|
|
|
IMPLT SCREW CORTICAL 2.7X14MM
|
Facility
|
OP
|
$2,737.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.25 |
| Max. Negotiated Rate |
$2,600.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,642.20
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$2,326.45
|
| Rate for Payer: First Health Commercial |
$2,463.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,463.30
|
| Rate for Payer: GEHA Commercial |
$2,189.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,463.30
|
| Rate for Payer: Humana ChoiceCare |
$711.62
|
| Rate for Payer: Multiplan All |
$2,490.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,642.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,915.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,463.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,600.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,052.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,408.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$684.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,545.41
|
| Rate for Payer: Zelis Auto |
$1,094.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,368.50
|
|
|
IMPLT SCREW CORTICAL 2.7X14MM
|
Facility
|
IP
|
$2,737.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.80 |
| Max. Negotiated Rate |
$2,600.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,189.60
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$2,326.45
|
| Rate for Payer: First Health Commercial |
$2,463.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,463.30
|
| Rate for Payer: GEHA Commercial |
$1,915.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,463.30
|
| Rate for Payer: Multiplan All |
$2,490.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,915.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,463.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,600.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,052.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,545.41
|
| Rate for Payer: Zelis Auto |
$1,094.80
|
|
|
IMPLT SCREW CORTICAL 2.7X14MM
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$348.80
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$305.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
|
|
IMPLT SCREW CORTICAL 2.7 X 16MM
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.80 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$365.60
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$319.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: Zelis Auto |
$182.80
|
|
