|
IMPLT SCREW PEEK 9X20MM
|
Facility
|
IP
|
$1,422.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.80 |
| Max. Negotiated Rate |
$1,350.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,137.60
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$1,208.70
|
| Rate for Payer: First Health Commercial |
$1,279.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,279.80
|
| Rate for Payer: GEHA Commercial |
$995.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,279.80
|
| Rate for Payer: Multiplan All |
$1,294.02
|
| Rate for Payer: OMNI Networks Commercial |
$995.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,279.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,350.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,322.46
|
| Rate for Payer: Zelis Auto |
$568.80
|
|
|
IMPLT SCREW PEEK 9X20MM
|
Facility
|
OP
|
$1,422.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$1,350.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$1,208.70
|
| Rate for Payer: First Health Commercial |
$1,279.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,279.80
|
| Rate for Payer: GEHA Commercial |
$1,137.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,279.80
|
| Rate for Payer: Humana ChoiceCare |
$369.72
|
| Rate for Payer: Multiplan All |
$1,294.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$853.20
|
| Rate for Payer: OMNI Networks Commercial |
$995.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,279.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,350.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,251.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,322.46
|
| Rate for Payer: Zelis Auto |
$568.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$711.00
|
|
|
IMPLT SCREW,PEG,2.5X18
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$540.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$472.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
|
|
IMPLT SCREW,PEG,2.5X18
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Humana ChoiceCare |
$175.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$405.00
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$594.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$337.50
|
|
|
IMPLT SCREW PEG 2.5X20MM
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Humana ChoiceCare |
$175.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$405.00
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$594.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$337.50
|
|
|
IMPLT SCREW PEG 2.5X20MM
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$540.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$472.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
|
|
IMPLT SCREW PEG 2.5X24MM
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$540.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Humana ChoiceCare |
$175.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$405.00
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$594.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$337.50
|
|
|
IMPLT SCREW PEG 2.5X24MM
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$540.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$472.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
|
|
IMPLT SCREW PEG NON LOCKING
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.75 |
| Max. Negotiated Rate |
$1,591.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,423.75
|
| Rate for Payer: First Health Commercial |
$1,507.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,507.50
|
| Rate for Payer: GEHA Commercial |
$1,340.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,507.50
|
| Rate for Payer: Humana ChoiceCare |
$435.50
|
| Rate for Payer: Multiplan All |
$1,524.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,005.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,172.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,507.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,591.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,256.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,474.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$418.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,557.75
|
| Rate for Payer: Zelis Auto |
$670.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$837.50
|
|
|
IMPLT SCREW PEG NON LOCKING
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.00 |
| Max. Negotiated Rate |
$1,591.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,340.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,423.75
|
| Rate for Payer: First Health Commercial |
$1,507.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,507.50
|
| Rate for Payer: GEHA Commercial |
$1,172.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,507.50
|
| Rate for Payer: Multiplan All |
$1,524.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,172.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,507.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,591.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,256.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,557.75
|
| Rate for Payer: Zelis Auto |
$670.00
|
|
|
IMPLT SCREW PEG NON LOCKING SP20
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.20 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$394.40
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$419.05
|
| Rate for Payer: First Health Commercial |
$443.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$443.70
|
| Rate for Payer: GEHA Commercial |
$345.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$443.70
|
| Rate for Payer: Multiplan All |
$448.63
|
| Rate for Payer: OMNI Networks Commercial |
$345.10
|
| Rate for Payer: One Health Plan PPO/POS |
$443.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$468.35
|
| Rate for Payer: Three Rivers Provider Network All |
$369.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$458.49
|
| Rate for Payer: Zelis Auto |
$197.20
|
|
|
IMPLT SCREW PEG NON LOCKING SP20
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.25 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$295.80
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$419.05
|
| Rate for Payer: First Health Commercial |
$443.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$443.70
|
| Rate for Payer: GEHA Commercial |
$394.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$443.70
|
| Rate for Payer: Humana ChoiceCare |
$128.18
|
| Rate for Payer: Multiplan All |
$448.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$295.80
|
| Rate for Payer: OMNI Networks Commercial |
$345.10
|
| Rate for Payer: One Health Plan PPO/POS |
$443.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$468.35
|
| Rate for Payer: Three Rivers Provider Network All |
$369.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$433.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$123.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$458.49
|
| Rate for Payer: Zelis Auto |
$197.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$246.50
|
|
|
IMPLT SCREW PERI-LOC 28MM
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006592
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$376.40 |
| Max. Negotiated Rate |
$893.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$752.80
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$799.85
|
| Rate for Payer: First Health Commercial |
$846.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.90
|
| Rate for Payer: GEHA Commercial |
$658.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.90
|
| Rate for Payer: Multiplan All |
$856.31
|
| Rate for Payer: OMNI Networks Commercial |
$658.70
|
| Rate for Payer: One Health Plan PPO/POS |
$846.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.95
|
| Rate for Payer: Three Rivers Provider Network All |
$705.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$875.13
|
| Rate for Payer: Zelis Auto |
$376.40
|
|
|
IMPLT SCREW PERI-LOC 28MM
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006592
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.25 |
| Max. Negotiated Rate |
$893.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$799.85
|
| Rate for Payer: First Health Commercial |
$846.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.90
|
| Rate for Payer: GEHA Commercial |
$752.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.90
|
| Rate for Payer: Humana ChoiceCare |
$244.66
|
| Rate for Payer: Multiplan All |
$856.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$564.60
|
| Rate for Payer: OMNI Networks Commercial |
$658.70
|
| Rate for Payer: One Health Plan PPO/POS |
$846.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.95
|
| Rate for Payer: Three Rivers Provider Network All |
$705.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$235.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$875.13
|
| Rate for Payer: Zelis Auto |
$376.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$470.50
|
|
|
IMPLT SCREW PERI-LOC 30MM
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.25 |
| Max. Negotiated Rate |
$893.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$799.85
|
| Rate for Payer: First Health Commercial |
$846.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.90
|
| Rate for Payer: GEHA Commercial |
$752.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.90
|
| Rate for Payer: Humana ChoiceCare |
$244.66
|
| Rate for Payer: Multiplan All |
$856.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$564.60
|
| Rate for Payer: OMNI Networks Commercial |
$658.70
|
| Rate for Payer: One Health Plan PPO/POS |
$846.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.95
|
| Rate for Payer: Three Rivers Provider Network All |
$705.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$235.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$875.13
|
| Rate for Payer: Zelis Auto |
$376.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$470.50
|
|
|
IMPLT SCREW PERI-LOC 30MM
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$376.40 |
| Max. Negotiated Rate |
$893.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$752.80
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$799.85
|
| Rate for Payer: First Health Commercial |
$846.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.90
|
| Rate for Payer: GEHA Commercial |
$658.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.90
|
| Rate for Payer: Multiplan All |
$856.31
|
| Rate for Payer: OMNI Networks Commercial |
$658.70
|
| Rate for Payer: One Health Plan PPO/POS |
$846.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.95
|
| Rate for Payer: Three Rivers Provider Network All |
$705.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$875.13
|
| Rate for Payer: Zelis Auto |
$376.40
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX12MM
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.60 |
| Max. Negotiated Rate |
$854.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$719.20
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cigna Commercial |
$764.15
|
| Rate for Payer: First Health Commercial |
$809.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$809.10
|
| Rate for Payer: GEHA Commercial |
$629.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$809.10
|
| Rate for Payer: Multiplan All |
$818.09
|
| Rate for Payer: OMNI Networks Commercial |
$629.30
|
| Rate for Payer: One Health Plan PPO/POS |
$809.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$854.05
|
| Rate for Payer: Three Rivers Provider Network All |
$674.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$836.07
|
| Rate for Payer: Zelis Auto |
$359.60
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX12MM
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.75 |
| Max. Negotiated Rate |
$854.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cigna Commercial |
$764.15
|
| Rate for Payer: First Health Commercial |
$809.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$809.10
|
| Rate for Payer: GEHA Commercial |
$719.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$809.10
|
| Rate for Payer: Humana ChoiceCare |
$233.74
|
| Rate for Payer: Multiplan All |
$818.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$539.40
|
| Rate for Payer: OMNI Networks Commercial |
$629.30
|
| Rate for Payer: One Health Plan PPO/POS |
$809.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$854.05
|
| Rate for Payer: Three Rivers Provider Network All |
$674.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$791.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$836.07
|
| Rate for Payer: Zelis Auto |
$359.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.50
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX20MM
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.60 |
| Max. Negotiated Rate |
$854.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$719.20
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cigna Commercial |
$764.15
|
| Rate for Payer: First Health Commercial |
$809.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$809.10
|
| Rate for Payer: GEHA Commercial |
$629.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$809.10
|
| Rate for Payer: Multiplan All |
$818.09
|
| Rate for Payer: OMNI Networks Commercial |
$629.30
|
| Rate for Payer: One Health Plan PPO/POS |
$809.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$854.05
|
| Rate for Payer: Three Rivers Provider Network All |
$674.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$836.07
|
| Rate for Payer: Zelis Auto |
$359.60
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX20MM
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.75 |
| Max. Negotiated Rate |
$854.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Cigna Commercial |
$764.15
|
| Rate for Payer: First Health Commercial |
$809.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$809.10
|
| Rate for Payer: GEHA Commercial |
$719.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$809.10
|
| Rate for Payer: Humana ChoiceCare |
$233.74
|
| Rate for Payer: Multiplan All |
$818.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$539.40
|
| Rate for Payer: OMNI Networks Commercial |
$629.30
|
| Rate for Payer: One Health Plan PPO/POS |
$809.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$854.05
|
| Rate for Payer: Three Rivers Provider Network All |
$674.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$791.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$836.07
|
| Rate for Payer: Zelis Auto |
$359.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.50
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX36MM
|
Facility
|
IP
|
$993.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$397.20 |
| Max. Negotiated Rate |
$943.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$794.40
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$844.05
|
| Rate for Payer: First Health Commercial |
$893.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$893.70
|
| Rate for Payer: GEHA Commercial |
$695.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$893.70
|
| Rate for Payer: Multiplan All |
$903.63
|
| Rate for Payer: OMNI Networks Commercial |
$695.10
|
| Rate for Payer: One Health Plan PPO/POS |
$893.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$943.35
|
| Rate for Payer: Three Rivers Provider Network All |
$744.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$923.49
|
| Rate for Payer: Zelis Auto |
$397.20
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX36MM
|
Facility
|
OP
|
$993.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.25 |
| Max. Negotiated Rate |
$943.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$844.05
|
| Rate for Payer: First Health Commercial |
$893.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$893.70
|
| Rate for Payer: GEHA Commercial |
$794.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$893.70
|
| Rate for Payer: Humana ChoiceCare |
$258.18
|
| Rate for Payer: Multiplan All |
$903.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$595.80
|
| Rate for Payer: OMNI Networks Commercial |
$695.10
|
| Rate for Payer: One Health Plan PPO/POS |
$893.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$943.35
|
| Rate for Payer: Three Rivers Provider Network All |
$744.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$873.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$248.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$923.49
|
| Rate for Payer: Zelis Auto |
$397.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$496.50
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX38MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$664.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$559.20
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$594.15
|
| Rate for Payer: First Health Commercial |
$629.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$629.10
|
| Rate for Payer: GEHA Commercial |
$489.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$629.10
|
| Rate for Payer: Multiplan All |
$636.09
|
| Rate for Payer: OMNI Networks Commercial |
$489.30
|
| Rate for Payer: One Health Plan PPO/POS |
$629.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$664.05
|
| Rate for Payer: Three Rivers Provider Network All |
$524.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$650.07
|
| Rate for Payer: Zelis Auto |
$279.60
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX38MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$664.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$594.15
|
| Rate for Payer: First Health Commercial |
$629.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$629.10
|
| Rate for Payer: GEHA Commercial |
$559.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$629.10
|
| Rate for Payer: Humana ChoiceCare |
$181.74
|
| Rate for Payer: Multiplan All |
$636.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$419.40
|
| Rate for Payer: OMNI Networks Commercial |
$489.30
|
| Rate for Payer: One Health Plan PPO/POS |
$629.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$664.05
|
| Rate for Payer: Three Rivers Provider Network All |
$524.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$615.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$174.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$650.07
|
| Rate for Payer: Zelis Auto |
$279.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$349.50
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX42MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$664.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$559.20
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$594.15
|
| Rate for Payer: First Health Commercial |
$629.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$629.10
|
| Rate for Payer: GEHA Commercial |
$489.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$629.10
|
| Rate for Payer: Multiplan All |
$636.09
|
| Rate for Payer: OMNI Networks Commercial |
$489.30
|
| Rate for Payer: One Health Plan PPO/POS |
$629.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$664.05
|
| Rate for Payer: Three Rivers Provider Network All |
$524.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$650.07
|
| Rate for Payer: Zelis Auto |
$279.60
|
|
