|
IMPLT SCREW PERI-LOC 3.5MMX42MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001006
|
|
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 3.5MMX46MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001008
|
|
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 3.5MMX46MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001009
|
|
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 3.5MMX46MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001009
|
|
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 3.5MMX46MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001008
|
|
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 3.5MMX55MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.40
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX55MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX60MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001012
|
|
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 3.5MMX60MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001012
|
|
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 3.5MMX65MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001013
|
|
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 3.5MMX65MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001013
|
|
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 3.5MMX70MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.40
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX70MM
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.20 |
| Max. Negotiated Rate |
$663.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$558.40
|
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Cigna Commercial |
$593.30
|
| Rate for Payer: First Health Commercial |
$628.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$628.20
|
| Rate for Payer: GEHA Commercial |
$488.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$628.20
|
| Rate for Payer: Multiplan All |
$635.18
|
| Rate for Payer: OMNI Networks Commercial |
$488.60
|
| Rate for Payer: One Health Plan PPO/POS |
$628.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$663.10
|
| Rate for Payer: Three Rivers Provider Network All |
$523.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$649.14
|
| Rate for Payer: Zelis Auto |
$279.20
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX70MM
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$663.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$418.80
|
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Cigna Commercial |
$593.30
|
| Rate for Payer: First Health Commercial |
$628.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$628.20
|
| Rate for Payer: GEHA Commercial |
$558.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$628.20
|
| Rate for Payer: Humana ChoiceCare |
$181.48
|
| Rate for Payer: Multiplan All |
$635.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$418.80
|
| Rate for Payer: OMNI Networks Commercial |
$488.60
|
| Rate for Payer: One Health Plan PPO/POS |
$628.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$663.10
|
| Rate for Payer: Three Rivers Provider Network All |
$523.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$614.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$174.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$649.14
|
| Rate for Payer: Zelis Auto |
$279.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$349.00
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX70MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
|
|
IMPLT SCREW PERI-LOC 3.5MMX75MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001016
|
|
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 3.5MMX75MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001016
|
|
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 3.5X18MM
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.20 |
| Max. Negotiated Rate |
$881.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$742.40
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cigna Commercial |
$788.80
|
| Rate for Payer: First Health Commercial |
$835.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$835.20
|
| Rate for Payer: GEHA Commercial |
$649.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$835.20
|
| Rate for Payer: Multiplan All |
$844.48
|
| Rate for Payer: OMNI Networks Commercial |
$649.60
|
| Rate for Payer: One Health Plan PPO/POS |
$835.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$881.60
|
| Rate for Payer: Three Rivers Provider Network All |
$696.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.04
|
| Rate for Payer: Zelis Auto |
$371.20
|
|
|
IMPLT SCREW PERI-LOC 3.5X18MM
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.00 |
| Max. Negotiated Rate |
$881.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cigna Commercial |
$788.80
|
| Rate for Payer: First Health Commercial |
$835.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$835.20
|
| Rate for Payer: GEHA Commercial |
$742.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$835.20
|
| Rate for Payer: Humana ChoiceCare |
$241.28
|
| Rate for Payer: Multiplan All |
$844.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$556.80
|
| Rate for Payer: OMNI Networks Commercial |
$649.60
|
| Rate for Payer: One Health Plan PPO/POS |
$835.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$881.60
|
| Rate for Payer: Three Rivers Provider Network All |
$696.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$816.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$232.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.04
|
| Rate for Payer: Zelis Auto |
$371.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$464.00
|
|
|
IMPLT SCREW PERI-LOC 3.5X32MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001564
|
|
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 3.5X32MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001564
|
|
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 3.5X34MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001002
|
|
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 3.5X34MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001002
|
|
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 3.5X40MM
|
Facility
|
IP
|
$993.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001005
|
|
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 3.5X40MM
|
Facility
|
OP
|
$993.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001005
|
|
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
|
|
