|
IMPLT SCREW CORTICAL 3.5X20MM
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$177.60
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$188.70
|
| Rate for Payer: First Health Commercial |
$199.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$199.80
|
| Rate for Payer: GEHA Commercial |
$155.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$199.80
|
| Rate for Payer: Multiplan All |
$202.02
|
| Rate for Payer: OMNI Networks Commercial |
$155.40
|
| Rate for Payer: One Health Plan PPO/POS |
$199.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$210.90
|
| Rate for Payer: Three Rivers Provider Network All |
$166.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$206.46
|
| Rate for Payer: Zelis Auto |
$88.80
|
|
|
IMPLT SCREW CORTICAL 3.5X20MM
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.25 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$183.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Humana ChoiceCare |
$59.54
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$137.40
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$201.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.50
|
|
|
IMPLT SCREW CORTICAL 3.5X20MM
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$192.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Humana ChoiceCare |
$62.40
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.00
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$211.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.00
|
|
|
IMPLT SCREW CORTICAL 3.5X22MM
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$259.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$218.40
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$232.05
|
| Rate for Payer: First Health Commercial |
$245.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$245.70
|
| Rate for Payer: GEHA Commercial |
$191.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$245.70
|
| Rate for Payer: Multiplan All |
$248.43
|
| Rate for Payer: OMNI Networks Commercial |
$191.10
|
| Rate for Payer: One Health Plan PPO/POS |
$245.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$259.35
|
| Rate for Payer: Three Rivers Provider Network All |
$204.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$253.89
|
| Rate for Payer: Zelis Auto |
$109.20
|
|
|
IMPLT SCREW CORTICAL 3.5X22MM
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$259.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$232.05
|
| Rate for Payer: First Health Commercial |
$245.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$245.70
|
| Rate for Payer: GEHA Commercial |
$218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$245.70
|
| Rate for Payer: Humana ChoiceCare |
$70.98
|
| Rate for Payer: Multiplan All |
$248.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$163.80
|
| Rate for Payer: OMNI Networks Commercial |
$191.10
|
| Rate for Payer: One Health Plan PPO/POS |
$245.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$259.35
|
| Rate for Payer: Three Rivers Provider Network All |
$204.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$240.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$68.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$253.89
|
| Rate for Payer: Zelis Auto |
$109.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$136.50
|
|
|
IMPLT SCREW CORTICAL 3.5X24MM
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.20 |
| Max. Negotiated Rate |
$553.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$466.40
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$495.55
|
| Rate for Payer: First Health Commercial |
$524.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$524.70
|
| Rate for Payer: GEHA Commercial |
$408.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$524.70
|
| Rate for Payer: Multiplan All |
$530.53
|
| Rate for Payer: OMNI Networks Commercial |
$408.10
|
| Rate for Payer: One Health Plan PPO/POS |
$524.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$553.85
|
| Rate for Payer: Three Rivers Provider Network All |
$437.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$542.19
|
| Rate for Payer: Zelis Auto |
$233.20
|
|
|
IMPLT SCREW CORTICAL 3.5X24MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Humana ChoiceCare |
$259.22
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$598.20
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$877.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$249.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.50
|
|
|
IMPLT SCREW CORTICAL 3.5X24MM
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002592
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.20
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$160.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
|
|
IMPLT SCREW CORTICAL 3.5X24MM
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$553.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$495.55
|
| Rate for Payer: First Health Commercial |
$524.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$524.70
|
| Rate for Payer: GEHA Commercial |
$466.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$524.70
|
| Rate for Payer: Humana ChoiceCare |
$151.58
|
| Rate for Payer: Multiplan All |
$530.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$349.80
|
| Rate for Payer: OMNI Networks Commercial |
$408.10
|
| Rate for Payer: One Health Plan PPO/POS |
$524.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$553.85
|
| Rate for Payer: Three Rivers Provider Network All |
$437.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$513.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$145.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$542.19
|
| Rate for Payer: Zelis Auto |
$233.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$291.50
|
|
|
IMPLT SCREW CORTICAL 3.5X24MM
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002592
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.25 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$183.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Humana ChoiceCare |
$59.54
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$137.40
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$201.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.50
|
|
|
IMPLT SCREW CORTICAL 3.5X24MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$797.60
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$697.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
|
|
IMPLT SCREW CORTICAL 3.5X26MM
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$192.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Humana ChoiceCare |
$62.40
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.00
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$211.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.00
|
|
|
IMPLT SCREW CORTICAL 3.5X26MM
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.40 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.80
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
|
|
IMPLT SCREW CORTICAL 3.5X26MM
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.20
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$160.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
|
|
IMPLT SCREW CORTICAL 3.5X26MM
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
|
|
IMPLT SCREW CORTICAL 3.5X26MM
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.40 |
| Max. Negotiated Rate |
$437.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$368.80
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$391.85
|
| Rate for Payer: First Health Commercial |
$414.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.90
|
| Rate for Payer: GEHA Commercial |
$322.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.90
|
| Rate for Payer: Multiplan All |
$419.51
|
| Rate for Payer: OMNI Networks Commercial |
$322.70
|
| Rate for Payer: One Health Plan PPO/POS |
$414.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.95
|
| Rate for Payer: Three Rivers Provider Network All |
$345.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$428.73
|
| Rate for Payer: Zelis Auto |
$184.40
|
|
|
IMPLT SCREW CORTICAL 3.5X26MM
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.25 |
| Max. Negotiated Rate |
$437.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$391.85
|
| Rate for Payer: First Health Commercial |
$414.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.90
|
| Rate for Payer: GEHA Commercial |
$368.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.90
|
| Rate for Payer: Humana ChoiceCare |
$119.86
|
| Rate for Payer: Multiplan All |
$419.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$276.60
|
| Rate for Payer: OMNI Networks Commercial |
$322.70
|
| Rate for Payer: One Health Plan PPO/POS |
$414.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.95
|
| Rate for Payer: Three Rivers Provider Network All |
$345.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$405.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$428.73
|
| Rate for Payer: Zelis Auto |
$184.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$230.50
|
|
|
IMPLT SCREW CORTICAL 3.5X26MM
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.25 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$183.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Humana ChoiceCare |
$59.54
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$137.40
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$201.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.50
|
|
|
IMPLT SCREW CORTICAL 3.5X26MM
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.20
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$160.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
|
|
IMPLT SCREW CORTICAL 3.5X26MM
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.25 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$183.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Humana ChoiceCare |
$59.54
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$137.40
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$201.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.50
|
|
|
IMPLT SCREW CORTICAL 3.5X26MM
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$300.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Humana ChoiceCare |
$97.76
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$225.60
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$330.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$188.00
|
|
|
IMPLT SCREW CORTICAL 35.X28MM
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$178.50
|
| Rate for Payer: First Health Commercial |
$189.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.00
|
| Rate for Payer: Humana ChoiceCare |
$54.60
|
| Rate for Payer: Multiplan All |
$191.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$126.00
|
| Rate for Payer: OMNI Networks Commercial |
$147.00
|
| Rate for Payer: One Health Plan PPO/POS |
$189.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$199.50
|
| Rate for Payer: Three Rivers Provider Network All |
$157.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$52.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$195.30
|
| Rate for Payer: Zelis Auto |
$84.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.00
|
|
|
IMPLT SCREW CORTICAL 35.X28MM
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$178.50
|
| Rate for Payer: First Health Commercial |
$189.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.00
|
| Rate for Payer: GEHA Commercial |
$147.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.00
|
| Rate for Payer: Multiplan All |
$191.10
|
| Rate for Payer: OMNI Networks Commercial |
$147.00
|
| Rate for Payer: One Health Plan PPO/POS |
$189.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$199.50
|
| Rate for Payer: Three Rivers Provider Network All |
$157.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$195.30
|
| Rate for Payer: Zelis Auto |
$84.00
|
|
|
IMPLT SCREW CORTICAL 3.5X28MM
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.40 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.80
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
|
|
IMPLT SCREW CORTICAL 3.5X28MM
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$553.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$495.55
|
| Rate for Payer: First Health Commercial |
$524.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$524.70
|
| Rate for Payer: GEHA Commercial |
$466.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$524.70
|
| Rate for Payer: Humana ChoiceCare |
$151.58
|
| Rate for Payer: Multiplan All |
$530.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$349.80
|
| Rate for Payer: OMNI Networks Commercial |
$408.10
|
| Rate for Payer: One Health Plan PPO/POS |
$524.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$553.85
|
| Rate for Payer: Three Rivers Provider Network All |
$437.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$513.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$145.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$542.19
|
| Rate for Payer: Zelis Auto |
$233.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$291.50
|
|
