|
IMPLT SCREW HEX LOW PROFILE 6.5X25MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.60
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
|
|
IMPLT SCREW HEX LOW PROFILE 6.5X30MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.60
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
|
|
IMPLT SCREW HEX LOW PROFILE 6.5X30MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$121.42
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$280.20
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$410.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.50
|
|
|
IMPLT SCREW HEX LOW PROFILE 6.5X35MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$121.42
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$280.20
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$410.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.50
|
|
|
IMPLT SCREW HEX LOW PROFILE 6.5X35MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$121.42
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$280.20
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$410.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.50
|
|
|
IMPLT SCREW HEX LOW PROFILE 6.5X35MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.60
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
|
|
IMPLT SCREW HEX LOW PROFILE 6.5X35MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.60
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
|
|
IMPLT SCREW INTERFERENCE BIO-COMPOSITE
|
Facility
|
OP
|
$1,618.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.50 |
| Max. Negotiated Rate |
$1,537.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$970.80
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cigna Commercial |
$1,375.30
|
| Rate for Payer: First Health Commercial |
$1,456.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,456.20
|
| Rate for Payer: GEHA Commercial |
$1,294.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,456.20
|
| Rate for Payer: Humana ChoiceCare |
$420.68
|
| Rate for Payer: Multiplan All |
$1,472.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$970.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,132.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,456.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,537.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,213.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,423.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$404.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,504.74
|
| Rate for Payer: Zelis Auto |
$647.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$809.00
|
|
|
IMPLT SCREW INTERFERENCE BIO-COMPOSITE
|
Facility
|
IP
|
$1,618.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.20 |
| Max. Negotiated Rate |
$1,537.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,294.40
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cigna Commercial |
$1,375.30
|
| Rate for Payer: First Health Commercial |
$1,456.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,456.20
|
| Rate for Payer: GEHA Commercial |
$1,132.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,456.20
|
| Rate for Payer: Multiplan All |
$1,472.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,132.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,456.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,537.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,213.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,504.74
|
| Rate for Payer: Zelis Auto |
$647.20
|
|
|
IMPLT SCREW INTERFERENCE SCREW
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$635.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Humana ChoiceCare |
$206.44
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.40
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$698.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$198.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$397.00
|
|
|
IMPLT SCREW INTERFERENCE SCREW
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$635.20
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$555.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
|
|
IMPLT SCREW INTERFERENCE SCREW
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$635.20
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$555.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
|
|
IMPLT SCREW INTERFERENCE SCREW
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$635.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Humana ChoiceCare |
$206.44
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.40
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$698.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$198.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$397.00
|
|
|
IMPLT SCREW INTERFERENCE SCREW 7 X 25
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$635.20
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$555.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
|
|
IMPLT SCREW INTERFERENCE SCREW 7 X 25
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$635.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Humana ChoiceCare |
$206.44
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.40
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$698.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$198.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$397.00
|
|
|
IMPLT SCREW INTERFERENCE SCREW 8 X 20
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$635.20
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$555.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
|
|
IMPLT SCREW INTERFERENCE SCREW 8 X 20
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$635.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Humana ChoiceCare |
$206.44
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.40
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$698.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$198.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$397.00
|
|
|
IMPLT SCREW INTERFERENCE SCREW 9 X 20
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$635.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Humana ChoiceCare |
$206.44
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.40
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$698.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$198.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$397.00
|
|
|
IMPLT SCREW INTERFERENCE SCREW 9 X 20
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$635.20
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$555.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
|
|
IMPLT SCREW INTERFERENCE SCREW 9 X 25
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$635.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Humana ChoiceCare |
$206.44
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.40
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$698.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$198.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$397.00
|
|
|
IMPLT SCREW INTERFERENCE SCREW 9 X 25
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$635.20
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$555.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
|
|
IMPLT SCREW LAG 95MM
|
Facility
|
IP
|
$2,234.52
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.81 |
| Max. Negotiated Rate |
$2,122.79 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,787.62
|
| Rate for Payer: Cash Price |
$1,340.71
|
| Rate for Payer: Cash Price |
$1,340.71
|
| Rate for Payer: Cigna Commercial |
$1,899.34
|
| Rate for Payer: First Health Commercial |
$2,011.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,011.07
|
| Rate for Payer: GEHA Commercial |
$1,564.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,011.07
|
| Rate for Payer: Multiplan All |
$2,033.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,564.16
|
| Rate for Payer: One Health Plan PPO/POS |
$2,011.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,122.79
|
| Rate for Payer: Three Rivers Provider Network All |
$1,675.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,078.10
|
| Rate for Payer: Zelis Auto |
$893.81
|
|
|
IMPLT SCREW LAG 95MM
|
Facility
|
OP
|
$2,234.52
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.63 |
| Max. Negotiated Rate |
$2,122.79 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,340.71
|
| Rate for Payer: Cash Price |
$1,340.71
|
| Rate for Payer: Cash Price |
$1,340.71
|
| Rate for Payer: Cigna Commercial |
$1,899.34
|
| Rate for Payer: First Health Commercial |
$2,011.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,011.07
|
| Rate for Payer: GEHA Commercial |
$1,787.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,011.07
|
| Rate for Payer: Humana ChoiceCare |
$580.98
|
| Rate for Payer: Multiplan All |
$2,033.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,340.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,564.16
|
| Rate for Payer: One Health Plan PPO/POS |
$2,011.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,122.79
|
| Rate for Payer: Three Rivers Provider Network All |
$1,675.89
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,966.38
|
| Rate for Payer: United Healthcare Managed Medicaid |
$558.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,078.10
|
| Rate for Payer: Zelis Auto |
$893.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,117.26
|
|
|
IMPLT SCREW LAG EXTRACTION 1806-6135
|
Facility
|
IP
|
$3,581.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.40 |
| Max. Negotiated Rate |
$3,401.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,864.80
|
| Rate for Payer: Cash Price |
$2,148.60
|
| Rate for Payer: Cash Price |
$2,148.60
|
| Rate for Payer: Cigna Commercial |
$3,043.85
|
| Rate for Payer: First Health Commercial |
$3,222.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,222.90
|
| Rate for Payer: GEHA Commercial |
$2,506.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,222.90
|
| Rate for Payer: Multiplan All |
$3,258.71
|
| Rate for Payer: OMNI Networks Commercial |
$2,506.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,222.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,401.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,685.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,330.33
|
| Rate for Payer: Zelis Auto |
$1,432.40
|
|
|
IMPLT SCREW LAG EXTRACTION 1806-6135
|
Facility
|
OP
|
$3,581.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.25 |
| Max. Negotiated Rate |
$3,401.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,148.60
|
| Rate for Payer: Cash Price |
$2,148.60
|
| Rate for Payer: Cash Price |
$2,148.60
|
| Rate for Payer: Cigna Commercial |
$3,043.85
|
| Rate for Payer: First Health Commercial |
$3,222.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,222.90
|
| Rate for Payer: GEHA Commercial |
$2,864.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,222.90
|
| Rate for Payer: Humana ChoiceCare |
$931.06
|
| Rate for Payer: Multiplan All |
$3,258.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,148.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,506.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,222.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,401.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,685.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,151.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$895.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,330.33
|
| Rate for Payer: Zelis Auto |
$1,432.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,790.50
|
|
