|
IMPLT SCREW SN PERI 4.0X14
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$200.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: First Health Commercial |
$225.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.00
|
| Rate for Payer: GEHA Commercial |
$175.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.00
|
| Rate for Payer: Multiplan All |
$227.50
|
| Rate for Payer: OMNI Networks Commercial |
$175.00
|
| Rate for Payer: One Health Plan PPO/POS |
$225.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$237.50
|
| Rate for Payer: Three Rivers Provider Network All |
$187.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$232.50
|
| Rate for Payer: Zelis Auto |
$100.00
|
|
|
IMPLT SCREW SN PERI 4.0X14
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.50 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: First Health Commercial |
$225.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.00
|
| Rate for Payer: GEHA Commercial |
$200.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.00
|
| Rate for Payer: Humana ChoiceCare |
$65.00
|
| Rate for Payer: Multiplan All |
$227.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$150.00
|
| Rate for Payer: OMNI Networks Commercial |
$175.00
|
| Rate for Payer: One Health Plan PPO/POS |
$225.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$237.50
|
| Rate for Payer: Three Rivers Provider Network All |
$187.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$220.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$232.50
|
| Rate for Payer: Zelis Auto |
$100.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$125.00
|
|
|
IMPLT SCREW SPHERICAL HEAD
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$300.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Humana ChoiceCare |
$97.76
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$225.60
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$330.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$188.00
|
|
|
IMPLT SCREW SPHERICAL HEAD
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.40 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.80
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
|
|
IMPLT SCREW SPHERICAL HEAD 15MM
|
Facility
|
OP
|
$7,101.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.25 |
| Max. Negotiated Rate |
$6,745.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,260.60
|
| Rate for Payer: Cash Price |
$4,260.60
|
| Rate for Payer: Cash Price |
$4,260.60
|
| Rate for Payer: Cigna Commercial |
$6,035.85
|
| Rate for Payer: First Health Commercial |
$6,390.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,390.90
|
| Rate for Payer: GEHA Commercial |
$5,680.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,390.90
|
| Rate for Payer: Humana ChoiceCare |
$1,846.26
|
| Rate for Payer: Multiplan All |
$6,461.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,260.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,970.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,390.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,745.95
|
| Rate for Payer: Three Rivers Provider Network All |
$5,325.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,248.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,775.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,603.93
|
| Rate for Payer: Zelis Auto |
$2,840.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,550.50
|
|
|
IMPLT SCREW SPHERICAL HEAD 15MM
|
Facility
|
IP
|
$7,101.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,840.40 |
| Max. Negotiated Rate |
$6,745.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,680.80
|
| Rate for Payer: Cash Price |
$4,260.60
|
| Rate for Payer: Cash Price |
$4,260.60
|
| Rate for Payer: Cigna Commercial |
$6,035.85
|
| Rate for Payer: First Health Commercial |
$6,390.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,390.90
|
| Rate for Payer: GEHA Commercial |
$4,970.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,390.90
|
| Rate for Payer: Multiplan All |
$6,461.91
|
| Rate for Payer: OMNI Networks Commercial |
$4,970.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,390.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,745.95
|
| Rate for Payer: Three Rivers Provider Network All |
$5,325.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,603.93
|
| Rate for Payer: Zelis Auto |
$2,840.40
|
|
|
IMPLT SCREW SPHERICAL HEAD 30MM
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$300.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Humana ChoiceCare |
$97.76
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$225.60
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$330.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$188.00
|
|
|
IMPLT SCREW SPHERICAL HEAD 30MM
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.40 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.80
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: First Health Commercial |
$338.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$338.40
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$338.40
|
| Rate for Payer: Multiplan All |
$342.16
|
| Rate for Payer: OMNI Networks Commercial |
$263.20
|
| Rate for Payer: One Health Plan PPO/POS |
$338.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$357.20
|
| Rate for Payer: Three Rivers Provider Network All |
$282.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$349.68
|
| Rate for Payer: Zelis Auto |
$150.40
|
|
|
IMPLT SCREW SPHERICAL HEAD 35MM
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.80 |
| Max. Negotiated Rate |
$771.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$649.60
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna Commercial |
$690.20
|
| Rate for Payer: First Health Commercial |
$730.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$730.80
|
| Rate for Payer: GEHA Commercial |
$568.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$730.80
|
| Rate for Payer: Multiplan All |
$738.92
|
| Rate for Payer: OMNI Networks Commercial |
$568.40
|
| Rate for Payer: One Health Plan PPO/POS |
$730.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$771.40
|
| Rate for Payer: Three Rivers Provider Network All |
$609.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$755.16
|
| Rate for Payer: Zelis Auto |
$324.80
|
|
|
IMPLT SCREW SPHERICAL HEAD 35MM
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$771.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna Commercial |
$690.20
|
| Rate for Payer: First Health Commercial |
$730.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$730.80
|
| Rate for Payer: GEHA Commercial |
$649.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$730.80
|
| Rate for Payer: Humana ChoiceCare |
$211.12
|
| Rate for Payer: Multiplan All |
$738.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$487.20
|
| Rate for Payer: OMNI Networks Commercial |
$568.40
|
| Rate for Payer: One Health Plan PPO/POS |
$730.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$771.40
|
| Rate for Payer: Three Rivers Provider Network All |
$609.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$714.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$203.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$755.16
|
| Rate for Payer: Zelis Auto |
$324.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.00
|
|
|
IMPLT SCREW STANDARD ACUTRAK2 16MM
|
Facility
|
IP
|
$2,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$829.20 |
| Max. Negotiated Rate |
$1,969.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cigna Commercial |
$1,762.05
|
| Rate for Payer: First Health Commercial |
$1,865.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,865.70
|
| Rate for Payer: GEHA Commercial |
$1,451.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,865.70
|
| Rate for Payer: Multiplan All |
$1,886.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,451.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,865.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,969.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,554.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,927.89
|
| Rate for Payer: Zelis Auto |
$829.20
|
|
|
IMPLT SCREW STANDARD ACUTRAK2 16MM
|
Facility
|
OP
|
$2,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.25 |
| Max. Negotiated Rate |
$1,969.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cigna Commercial |
$1,762.05
|
| Rate for Payer: First Health Commercial |
$1,865.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,865.70
|
| Rate for Payer: GEHA Commercial |
$1,658.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,865.70
|
| Rate for Payer: Humana ChoiceCare |
$538.98
|
| Rate for Payer: Multiplan All |
$1,886.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,243.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,451.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,865.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,969.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,554.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,824.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$518.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,927.89
|
| Rate for Payer: Zelis Auto |
$829.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,036.50
|
|
|
IMPLT SCREW STANDARD ACUTRAK2 20MM
|
Facility
|
IP
|
$2,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$829.20 |
| Max. Negotiated Rate |
$1,969.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cigna Commercial |
$1,762.05
|
| Rate for Payer: First Health Commercial |
$1,865.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,865.70
|
| Rate for Payer: GEHA Commercial |
$1,451.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,865.70
|
| Rate for Payer: Multiplan All |
$1,886.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,451.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,865.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,969.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,554.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,927.89
|
| Rate for Payer: Zelis Auto |
$829.20
|
|
|
IMPLT SCREW STANDARD ACUTRAK2 20MM
|
Facility
|
OP
|
$2,073.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.25 |
| Max. Negotiated Rate |
$1,969.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cigna Commercial |
$1,762.05
|
| Rate for Payer: First Health Commercial |
$1,865.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,865.70
|
| Rate for Payer: GEHA Commercial |
$1,658.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,865.70
|
| Rate for Payer: Humana ChoiceCare |
$538.98
|
| Rate for Payer: Multiplan All |
$1,886.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,243.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,451.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,865.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,969.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,554.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,824.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$518.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,927.89
|
| Rate for Payer: Zelis Auto |
$829.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,036.50
|
|
|
IMPLT SCREW S/T CORTEX 3.5 40MM
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$191.25
|
| Rate for Payer: First Health Commercial |
$202.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$202.50
|
| Rate for Payer: GEHA Commercial |
$157.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$202.50
|
| Rate for Payer: Multiplan All |
$204.75
|
| Rate for Payer: OMNI Networks Commercial |
$157.50
|
| Rate for Payer: One Health Plan PPO/POS |
$202.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$213.75
|
| Rate for Payer: Three Rivers Provider Network All |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$209.25
|
| Rate for Payer: Zelis Auto |
$90.00
|
|
|
IMPLT SCREW S/T CORTEX 3.5 40MM
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$191.25
|
| Rate for Payer: First Health Commercial |
$202.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$202.50
|
| Rate for Payer: GEHA Commercial |
$180.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$202.50
|
| Rate for Payer: Humana ChoiceCare |
$58.50
|
| Rate for Payer: Multiplan All |
$204.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$135.00
|
| Rate for Payer: OMNI Networks Commercial |
$157.50
|
| Rate for Payer: One Health Plan PPO/POS |
$202.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$213.75
|
| Rate for Payer: Three Rivers Provider Network All |
$168.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$209.25
|
| Rate for Payer: Zelis Auto |
$90.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$112.50
|
|
|
IMPLT SCREW SYN CANC FT 4.0 X 18 MM
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$185.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Humana ChoiceCare |
$60.32
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$139.20
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$204.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$58.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$116.00
|
|
|
IMPLT SCREW SYN CANC FT 4.0 X 18 MM
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$185.60
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
|
|
IMPLT SCREW SYN CORTE 2.7X20MM
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$95.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
|
|
IMPLT SCREW SYN CORTE 2.7X20MM
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$115.60
|
| Rate for Payer: First Health Commercial |
$122.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$122.40
|
| Rate for Payer: GEHA Commercial |
$108.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$35.36
|
| Rate for Payer: Multiplan All |
$123.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$81.60
|
| Rate for Payer: OMNI Networks Commercial |
$95.20
|
| Rate for Payer: One Health Plan PPO/POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$129.20
|
| Rate for Payer: Three Rivers Provider Network All |
$102.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$126.48
|
| Rate for Payer: Zelis Auto |
$54.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$68.00
|
|
|
IMPLT SCREW SYN CORTE SYN 2.7X12MM
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$260.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$227.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: Zelis Auto |
$130.00
|
|
|
IMPLT SCREW SYN CORTE SYN 2.7X12MM
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$260.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| Rate for Payer: Humana ChoiceCare |
$84.50
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$195.00
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$286.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: Zelis Auto |
$130.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.50
|
|
|
IMPLT SCREW/SYN CORTEX 2.0X16
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$351.20
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cigna Commercial |
$373.15
|
| Rate for Payer: First Health Commercial |
$395.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$395.10
|
| Rate for Payer: GEHA Commercial |
$307.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$395.10
|
| Rate for Payer: Multiplan All |
$399.49
|
| Rate for Payer: OMNI Networks Commercial |
$307.30
|
| Rate for Payer: One Health Plan PPO/POS |
$395.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$417.05
|
| Rate for Payer: Three Rivers Provider Network All |
$329.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$408.27
|
| Rate for Payer: Zelis Auto |
$175.60
|
|
|
IMPLT SCREW/SYN CORTEX 2.0X16
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.75 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$263.40
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cigna Commercial |
$373.15
|
| Rate for Payer: First Health Commercial |
$395.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$395.10
|
| Rate for Payer: GEHA Commercial |
$351.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$395.10
|
| Rate for Payer: Humana ChoiceCare |
$114.14
|
| Rate for Payer: Multiplan All |
$399.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$263.40
|
| Rate for Payer: OMNI Networks Commercial |
$307.30
|
| Rate for Payer: One Health Plan PPO/POS |
$395.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$417.05
|
| Rate for Payer: Three Rivers Provider Network All |
$329.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$386.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$109.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$408.27
|
| Rate for Payer: Zelis Auto |
$175.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$219.50
|
|
|
IMPLT SCREW SYNTHES 2.0MM X 14MM
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$156.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$165.75
|
| Rate for Payer: First Health Commercial |
$175.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$175.50
|
| Rate for Payer: GEHA Commercial |
$136.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$175.50
|
| Rate for Payer: Multiplan All |
$177.45
|
| Rate for Payer: OMNI Networks Commercial |
$136.50
|
| Rate for Payer: One Health Plan PPO/POS |
$175.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$185.25
|
| Rate for Payer: Three Rivers Provider Network All |
$146.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$181.35
|
| Rate for Payer: Zelis Auto |
$78.00
|
|
