|
IMPLT SCREW CORTICAL 36MM
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.75 |
| Max. Negotiated Rate |
$732.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$655.35
|
| Rate for Payer: First Health Commercial |
$693.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.90
|
| Rate for Payer: GEHA Commercial |
$616.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.90
|
| Rate for Payer: Humana ChoiceCare |
$200.46
|
| Rate for Payer: Multiplan All |
$701.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$462.60
|
| Rate for Payer: OMNI Networks Commercial |
$539.70
|
| Rate for Payer: One Health Plan PPO/POS |
$693.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$732.45
|
| Rate for Payer: Three Rivers Provider Network All |
$578.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$678.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$192.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$717.03
|
| Rate for Payer: Zelis Auto |
$308.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$385.50
|
|
|
IMPLT SCREW CORTICAL 38MM
|
Facility
|
OP
|
$1,932.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$1,835.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cigna Commercial |
$1,642.20
|
| Rate for Payer: First Health Commercial |
$1,738.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,738.80
|
| Rate for Payer: GEHA Commercial |
$1,545.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$502.32
|
| Rate for Payer: Multiplan All |
$1,758.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,159.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,352.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,738.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,835.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,449.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,700.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$483.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,796.76
|
| Rate for Payer: Zelis Auto |
$772.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$966.00
|
|
|
IMPLT SCREW CORTICAL 38MM
|
Facility
|
IP
|
$1,932.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$772.80 |
| Max. Negotiated Rate |
$1,835.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,545.60
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cigna Commercial |
$1,642.20
|
| Rate for Payer: First Health Commercial |
$1,738.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,738.80
|
| Rate for Payer: GEHA Commercial |
$1,352.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,738.80
|
| Rate for Payer: Multiplan All |
$1,758.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,352.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,738.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,835.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,449.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,796.76
|
| Rate for Payer: Zelis Auto |
$772.80
|
|
|
IMPLT SCREW CORTICAL 40MM
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$308.40 |
| Max. Negotiated Rate |
$732.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$616.80
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$655.35
|
| Rate for Payer: First Health Commercial |
$693.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.90
|
| Rate for Payer: GEHA Commercial |
$539.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.90
|
| Rate for Payer: Multiplan All |
$701.61
|
| Rate for Payer: OMNI Networks Commercial |
$539.70
|
| Rate for Payer: One Health Plan PPO/POS |
$693.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$732.45
|
| Rate for Payer: Three Rivers Provider Network All |
$578.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$717.03
|
| Rate for Payer: Zelis Auto |
$308.40
|
|
|
IMPLT SCREW CORTICAL 40MM
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.75 |
| Max. Negotiated Rate |
$732.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$655.35
|
| Rate for Payer: First Health Commercial |
$693.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.90
|
| Rate for Payer: GEHA Commercial |
$616.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.90
|
| Rate for Payer: Humana ChoiceCare |
$200.46
|
| Rate for Payer: Multiplan All |
$701.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$462.60
|
| Rate for Payer: OMNI Networks Commercial |
$539.70
|
| Rate for Payer: One Health Plan PPO/POS |
$693.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$732.45
|
| Rate for Payer: Three Rivers Provider Network All |
$578.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$678.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$192.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$717.03
|
| Rate for Payer: Zelis Auto |
$308.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$385.50
|
|
|
IMPLT SCREW CORTICAL 42MM
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$308.40 |
| Max. Negotiated Rate |
$732.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$616.80
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$655.35
|
| Rate for Payer: First Health Commercial |
$693.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.90
|
| Rate for Payer: GEHA Commercial |
$539.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.90
|
| Rate for Payer: Multiplan All |
$701.61
|
| Rate for Payer: OMNI Networks Commercial |
$539.70
|
| Rate for Payer: One Health Plan PPO/POS |
$693.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$732.45
|
| Rate for Payer: Three Rivers Provider Network All |
$578.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$717.03
|
| Rate for Payer: Zelis Auto |
$308.40
|
|
|
IMPLT SCREW CORTICAL 42MM
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.75 |
| Max. Negotiated Rate |
$732.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$655.35
|
| Rate for Payer: First Health Commercial |
$693.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.90
|
| Rate for Payer: GEHA Commercial |
$616.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.90
|
| Rate for Payer: Humana ChoiceCare |
$200.46
|
| Rate for Payer: Multiplan All |
$701.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$462.60
|
| Rate for Payer: OMNI Networks Commercial |
$539.70
|
| Rate for Payer: One Health Plan PPO/POS |
$693.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$732.45
|
| Rate for Payer: Three Rivers Provider Network All |
$578.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$678.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$192.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$717.03
|
| Rate for Payer: Zelis Auto |
$308.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$385.50
|
|
|
IMPLT SCREW CORTICAL 4.5X 26MM
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009210
|
|
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 4.5X 26MM
|
Facility
|
OP
|
$1,682.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009210
|
|
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 4.5X30MM
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
|
|
IMPLT SCREW CORTICAL 4.5X30MM
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$87.36
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.60
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.00
|
|
|
IMPLT SCREW CORTICAL 4.5X30MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001468
|
|
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 4.5X30MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001468
|
|
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 4.5X34MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001469
|
|
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 4.5X34MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001469
|
|
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 4.5X36MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001470
|
|
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 4.5X36MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001470
|
|
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 4.5X38MM
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$221.60
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cigna Commercial |
$235.45
|
| Rate for Payer: First Health Commercial |
$249.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$249.30
|
| Rate for Payer: GEHA Commercial |
$193.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$249.30
|
| Rate for Payer: Multiplan All |
$252.07
|
| Rate for Payer: OMNI Networks Commercial |
$193.90
|
| Rate for Payer: One Health Plan PPO/POS |
$249.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$263.15
|
| Rate for Payer: Three Rivers Provider Network All |
$207.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$257.61
|
| Rate for Payer: Zelis Auto |
$110.80
|
|
|
IMPLT SCREW CORTICAL 4.5X38MM
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.25 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cigna Commercial |
$235.45
|
| Rate for Payer: First Health Commercial |
$249.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$249.30
|
| Rate for Payer: GEHA Commercial |
$221.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$249.30
|
| Rate for Payer: Humana ChoiceCare |
$72.02
|
| Rate for Payer: Multiplan All |
$252.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$166.20
|
| Rate for Payer: OMNI Networks Commercial |
$193.90
|
| Rate for Payer: One Health Plan PPO/POS |
$249.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$263.15
|
| Rate for Payer: Three Rivers Provider Network All |
$207.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$243.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$257.61
|
| Rate for Payer: Zelis Auto |
$110.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$138.50
|
|
|
IMPLT SCREW CORTICAL 4.5X40MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001471
|
|
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 4.5X40MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001471
|
|
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 4.5X42MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001472
|
|
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 4.5X42MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001472
|
|
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 4.5X44MM
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
|
|
IMPLT SCREW CORTICAL 4.5X44MM
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$87.36
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.60
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.00
|
|
