|
IMPLT SCREW LOCKING 2.7X48MM
|
Facility
|
IP
|
$869.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.60 |
| Max. Negotiated Rate |
$825.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$695.20
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$738.65
|
| Rate for Payer: First Health Commercial |
$782.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$782.10
|
| Rate for Payer: GEHA Commercial |
$608.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$782.10
|
| Rate for Payer: Multiplan All |
$790.79
|
| Rate for Payer: OMNI Networks Commercial |
$608.30
|
| Rate for Payer: One Health Plan PPO/POS |
$782.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$825.55
|
| Rate for Payer: Three Rivers Provider Network All |
$651.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$808.17
|
| Rate for Payer: Zelis Auto |
$347.60
|
|
|
IMPLT SCREW LOCKING 2.7X50MM
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$49.92
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.20
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.00
|
|
|
IMPLT SCREW LOCKING 2.7X50MM
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006265
|
|
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 LOCKING 2.7X50MM
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
|
|
IMPLT SCREW LOCKING 2.7X50MM
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006265
|
|
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 LOCKING 2.7X55MM
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006266
|
|
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 LOCKING 2.7X55MM
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006266
|
|
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 LOCKING 3.0X10MM
|
Facility
|
IP
|
$1,378.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.20 |
| Max. Negotiated Rate |
$1,309.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,102.40
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$1,171.30
|
| Rate for Payer: First Health Commercial |
$1,240.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,240.20
|
| Rate for Payer: GEHA Commercial |
$964.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,240.20
|
| Rate for Payer: Multiplan All |
$1,253.98
|
| Rate for Payer: OMNI Networks Commercial |
$964.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,240.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,309.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,033.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,281.54
|
| Rate for Payer: Zelis Auto |
$551.20
|
|
|
IMPLT SCREW LOCKING 3.0X10MM
|
Facility
|
OP
|
$1,378.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.50 |
| Max. Negotiated Rate |
$1,309.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$1,171.30
|
| Rate for Payer: First Health Commercial |
$1,240.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,240.20
|
| Rate for Payer: GEHA Commercial |
$1,102.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,240.20
|
| Rate for Payer: Humana ChoiceCare |
$358.28
|
| Rate for Payer: Multiplan All |
$1,253.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$826.80
|
| Rate for Payer: OMNI Networks Commercial |
$964.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,240.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,309.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,033.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,212.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$344.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,281.54
|
| Rate for Payer: Zelis Auto |
$551.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$689.00
|
|
|
IMPLT SCREW LOCKING 3.0X12MM
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$512.55
|
| Rate for Payer: First Health Commercial |
$542.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.70
|
| Rate for Payer: GEHA Commercial |
$482.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.70
|
| Rate for Payer: Humana ChoiceCare |
$156.78
|
| Rate for Payer: Multiplan All |
$548.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$361.80
|
| Rate for Payer: OMNI Networks Commercial |
$422.10
|
| Rate for Payer: One Health Plan PPO/POS |
$542.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.85
|
| Rate for Payer: Three Rivers Provider Network All |
$452.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$530.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.79
|
| Rate for Payer: Zelis Auto |
$241.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$301.50
|
|
|
IMPLT SCREW LOCKING 3.0X12MM
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$482.40
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$512.55
|
| Rate for Payer: First Health Commercial |
$542.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.70
|
| Rate for Payer: GEHA Commercial |
$422.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.70
|
| Rate for Payer: Multiplan All |
$548.73
|
| Rate for Payer: OMNI Networks Commercial |
$422.10
|
| Rate for Payer: One Health Plan PPO/POS |
$542.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.85
|
| Rate for Payer: Three Rivers Provider Network All |
$452.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.79
|
| Rate for Payer: Zelis Auto |
$241.20
|
|
|
IMPLT SCREW LOCKING 3.0X14MM
|
Facility
|
IP
|
$1,378.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.20 |
| Max. Negotiated Rate |
$1,309.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,102.40
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$1,171.30
|
| Rate for Payer: First Health Commercial |
$1,240.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,240.20
|
| Rate for Payer: GEHA Commercial |
$964.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,240.20
|
| Rate for Payer: Multiplan All |
$1,253.98
|
| Rate for Payer: OMNI Networks Commercial |
$964.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,240.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,309.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,033.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,281.54
|
| Rate for Payer: Zelis Auto |
$551.20
|
|
|
IMPLT SCREW LOCKING 3.0X14MM
|
Facility
|
OP
|
$3,691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.75 |
| Max. Negotiated Rate |
$3,506.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,214.60
|
| Rate for Payer: Cash Price |
$2,214.60
|
| Rate for Payer: Cash Price |
$2,214.60
|
| Rate for Payer: Cigna Commercial |
$3,137.35
|
| Rate for Payer: First Health Commercial |
$3,321.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,321.90
|
| Rate for Payer: GEHA Commercial |
$2,952.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,321.90
|
| Rate for Payer: Humana ChoiceCare |
$959.66
|
| Rate for Payer: Multiplan All |
$3,358.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,214.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,583.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,321.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,506.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,768.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,248.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$922.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,432.63
|
| Rate for Payer: Zelis Auto |
$1,476.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,845.50
|
|
|
IMPLT SCREW LOCKING 3.0X14MM
|
Facility
|
OP
|
$1,378.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.50 |
| Max. Negotiated Rate |
$1,309.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$1,171.30
|
| Rate for Payer: First Health Commercial |
$1,240.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,240.20
|
| Rate for Payer: GEHA Commercial |
$1,102.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,240.20
|
| Rate for Payer: Humana ChoiceCare |
$358.28
|
| Rate for Payer: Multiplan All |
$1,253.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$826.80
|
| Rate for Payer: OMNI Networks Commercial |
$964.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,240.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,309.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,033.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,212.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$344.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,281.54
|
| Rate for Payer: Zelis Auto |
$551.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$689.00
|
|
|
IMPLT SCREW LOCKING 3.0X14MM
|
Facility
|
IP
|
$3,691.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,476.40 |
| Max. Negotiated Rate |
$3,506.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,952.80
|
| Rate for Payer: Cash Price |
$2,214.60
|
| Rate for Payer: Cash Price |
$2,214.60
|
| Rate for Payer: Cigna Commercial |
$3,137.35
|
| Rate for Payer: First Health Commercial |
$3,321.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,321.90
|
| Rate for Payer: GEHA Commercial |
$2,583.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,321.90
|
| Rate for Payer: Multiplan All |
$3,358.81
|
| Rate for Payer: OMNI Networks Commercial |
$2,583.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,321.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,506.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,768.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,432.63
|
| Rate for Payer: Zelis Auto |
$1,476.40
|
|
|
IMPLT SCREW LOCKING 3.0X16MM
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$482.40
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$512.55
|
| Rate for Payer: First Health Commercial |
$542.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.70
|
| Rate for Payer: GEHA Commercial |
$422.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.70
|
| Rate for Payer: Multiplan All |
$548.73
|
| Rate for Payer: OMNI Networks Commercial |
$422.10
|
| Rate for Payer: One Health Plan PPO/POS |
$542.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.85
|
| Rate for Payer: Three Rivers Provider Network All |
$452.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.79
|
| Rate for Payer: Zelis Auto |
$241.20
|
|
|
IMPLT SCREW LOCKING 3.0X16MM
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$512.55
|
| Rate for Payer: First Health Commercial |
$542.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$542.70
|
| Rate for Payer: GEHA Commercial |
$482.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$542.70
|
| Rate for Payer: Humana ChoiceCare |
$156.78
|
| Rate for Payer: Multiplan All |
$548.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$361.80
|
| Rate for Payer: OMNI Networks Commercial |
$422.10
|
| Rate for Payer: One Health Plan PPO/POS |
$542.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$572.85
|
| Rate for Payer: Three Rivers Provider Network All |
$452.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$530.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$560.79
|
| Rate for Payer: Zelis Auto |
$241.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$301.50
|
|
|
IMPLT SCREW LOCKING 30X4.75MM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
|
|
IMPLT SCREW LOCKING 30X4.75MM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$171.60
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$396.00
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$580.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$330.00
|
|
|
IMPLT SCREW LOCKING 3.5X10MM
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.60
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$316.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
|
|
IMPLT SCREW LOCKING 3.5X10MM
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.75 |
| Max. Negotiated Rate |
$842.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$753.95
|
| Rate for Payer: First Health Commercial |
$798.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.30
|
| Rate for Payer: GEHA Commercial |
$709.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.30
|
| Rate for Payer: Humana ChoiceCare |
$230.62
|
| Rate for Payer: Multiplan All |
$807.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$532.20
|
| Rate for Payer: OMNI Networks Commercial |
$620.90
|
| Rate for Payer: One Health Plan PPO/POS |
$798.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.65
|
| Rate for Payer: Three Rivers Provider Network All |
$665.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$780.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$221.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$824.91
|
| Rate for Payer: Zelis Auto |
$354.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$443.50
|
|
|
IMPLT SCREW LOCKING 3.5X10MM
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$704.80
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$616.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
|
|
IMPLT SCREW LOCKING 3.5X10MM
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.25 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$608.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Humana ChoiceCare |
$197.86
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$456.60
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$669.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$190.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$380.50
|
|
|
IMPLT SCREW LOCKING 3.5X10MM
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$361.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Humana ChoiceCare |
$117.52
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$271.20
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$397.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$113.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.00
|
|
|
IMPLT SCREW LOCKING 3.5X10MM
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$637.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Humana ChoiceCare |
$207.22
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$478.20
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$701.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$199.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: Zelis Auto |
$318.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$398.50
|
|
