|
IMPLT SCREW PERI-LOC 3.5X44MM
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001007
|
|
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 3.5X44MM
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001007
|
|
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 3.5X48MM
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.60
|
| 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 |
$704.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Humana ChoiceCare |
$229.06
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$528.60
|
| 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: TriWest Veterans Administration/VAPC3 |
$775.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$440.50
|
|
|
IMPLT SCREW PERI-LOC 3.5X48MM
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000997
|
|
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 PERI-LOC 3.5X50MM
|
Facility
|
IP
|
$993.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001011
|
|
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 3.5X50MM
|
Facility
|
OP
|
$993.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001011
|
|
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 3.5X55MM SELF TAP
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.60
|
| 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 |
$704.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Humana ChoiceCare |
$229.06
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$528.60
|
| 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: TriWest Veterans Administration/VAPC3 |
$775.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$440.50
|
|
|
IMPLT SCREW PERI-LOC 3.5X55MM SELF TAP
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000998
|
|
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 PERI-LOC 3.6MMX26MM
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001017
|
|
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 3.6MMX26MM
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001017
|
|
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 3.6MMX28MM
|
Facility
|
IP
|
$993.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001018
|
|
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 3.6MMX28MM
|
Facility
|
OP
|
$993.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001018
|
|
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 48MM
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000617
|
|
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 48MM
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000617
|
|
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 52MM
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006594
|
|
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 52MM
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006594
|
|
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 CORTEX 3.5X32MM
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$204.80
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$179.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: Zelis Auto |
$102.40
|
|
|
IMPLT SCREW PERI-LOC CORTEX 3.5X32MM
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: First Health Commercial |
$230.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$230.40
|
| Rate for Payer: GEHA Commercial |
$204.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$230.40
|
| Rate for Payer: Humana ChoiceCare |
$66.56
|
| Rate for Payer: Multiplan All |
$232.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$153.60
|
| Rate for Payer: OMNI Networks Commercial |
$179.20
|
| Rate for Payer: One Health Plan PPO/POS |
$230.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$243.20
|
| Rate for Payer: Three Rivers Provider Network All |
$192.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$225.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$64.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$238.08
|
| Rate for Payer: Zelis Auto |
$102.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$128.00
|
|
|
IMPLT SCREW PERI-LOC CORTEX 3.5X50MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001566
|
|
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 CORTEX 3.5X50MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001566
|
|
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 CRTX 3.5MMX26MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001019
|
|
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 CRTX 3.5MMX26MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001019
|
|
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 CRTX 3.5MMX28MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001020
|
|
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 CRTX 3.5MMX28MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001020
|
|
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 CRTX 3.5MMX30
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$176.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
|
