|
IMPLT SCREW CORTICAL 2.7 X 16MM
|
Facility
|
OP
|
$1,314.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003531
|
|
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 16MM
|
Facility
|
IP
|
$1,314.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003531
|
|
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 16MM
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.25 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$274.20
|
| 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 |
$365.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Humana ChoiceCare |
$118.82
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$274.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$402.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: Zelis Auto |
$182.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$228.50
|
|
|
IMPLT SCREW CORTICAL 2.7X24MM
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002981
|
|
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 2.7X24MM
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002981
|
|
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 2.7X46MM
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001466
|
|
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 2.7X46MM
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001466
|
|
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 3.5X10MM
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$210.40
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$184.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
|
|
IMPLT SCREW CORTICAL 3.5X10MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.40
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
|
|
IMPLT SCREW CORTICAL 3.5X10MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
|
|
IMPLT SCREW CORTICAL 3.5X10MM
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Humana ChoiceCare |
$175.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$405.00
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$594.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$337.50
|
|
|
IMPLT SCREW CORTICAL 3.5X10MM
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.75 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$210.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Humana ChoiceCare |
$68.38
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$157.80
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$231.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$131.50
|
|
|
IMPLT SCREW CORTICAL 3.5X10MM
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$540.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$472.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
|
|
IMPLT SCREW CORTICAL 3.5X12MM
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.20 |
| Max. Negotiated Rate |
$1,499.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,262.40
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cigna Commercial |
$1,341.30
|
| Rate for Payer: First Health Commercial |
$1,420.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,420.20
|
| Rate for Payer: GEHA Commercial |
$1,104.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,420.20
|
| Rate for Payer: Multiplan All |
$1,435.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,104.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,420.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,499.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,183.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,467.54
|
| Rate for Payer: Zelis Auto |
$631.20
|
|
|
IMPLT SCREW CORTICAL 3.5X12MM
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$210.40
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$184.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
|
|
IMPLT SCREW CORTICAL 3.5X12MM
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.20
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.00
|
|
|
IMPLT SCREW CORTICAL 3.5X12MM
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$210.40
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$184.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
|
|
IMPLT SCREW CORTICAL 3.5X12MM
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Humana ChoiceCare |
$175.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$405.00
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$594.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$337.50
|
|
|
IMPLT SCREW CORTICAL 3.5X12MM
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.50 |
| Max. Negotiated Rate |
$1,499.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$946.80
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cigna Commercial |
$1,341.30
|
| Rate for Payer: First Health Commercial |
$1,420.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,420.20
|
| Rate for Payer: GEHA Commercial |
$1,262.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,420.20
|
| Rate for Payer: Humana ChoiceCare |
$410.28
|
| Rate for Payer: Multiplan All |
$1,435.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$946.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,104.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,420.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,499.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,183.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,388.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$394.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,467.54
|
| Rate for Payer: Zelis Auto |
$631.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.00
|
|
|
IMPLT SCREW CORTICAL 3.5X12MM
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.75 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$210.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Humana ChoiceCare |
$68.38
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$157.80
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$231.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$131.50
|
|
|
IMPLT SCREW CORTICAL 3.5X12MM
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.75 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$210.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Humana ChoiceCare |
$68.38
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$157.80
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$231.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$131.50
|
|
|
IMPLT SCREW CORTICAL 3.5X12MM
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$704.80
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$616.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
|
|
IMPLT SCREW CORTICAL 3.5X12MM
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
|
|
IMPLT SCREW CORTICAL 3.5X12MM
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$704.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Humana ChoiceCare |
$229.06
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$528.60
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$775.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$440.50
|
|
|
IMPLT SCREW CORTICAL 3.5X12MM
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$540.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$472.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
|
