|
IMPLT SCREW 2.5 CORTEX 14MM
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.60
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$186.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
|
|
IMPLT SCREW 2.5 CORTEX 14MM
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.60
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$186.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
|
|
IMPLT SCREW 2.5 CORTEX 14MM
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$213.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Humana ChoiceCare |
$69.42
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$160.20
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$234.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$133.50
|
|
|
IMPLT SCREW 2.5 CORTEX 20MM
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: First Health Commercial |
$193.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$193.50
|
| Rate for Payer: GEHA Commercial |
$172.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$193.50
|
| Rate for Payer: Humana ChoiceCare |
$55.90
|
| Rate for Payer: Multiplan All |
$195.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$129.00
|
| Rate for Payer: OMNI Networks Commercial |
$150.50
|
| Rate for Payer: One Health Plan PPO/POS |
$193.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$204.25
|
| Rate for Payer: Three Rivers Provider Network All |
$161.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$189.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.95
|
| Rate for Payer: Zelis Auto |
$86.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.50
|
|
|
IMPLT SCREW 2.5 CORTEX 20MM
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: First Health Commercial |
$193.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$193.50
|
| Rate for Payer: GEHA Commercial |
$150.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$193.50
|
| Rate for Payer: Multiplan All |
$195.65
|
| Rate for Payer: OMNI Networks Commercial |
$150.50
|
| Rate for Payer: One Health Plan PPO/POS |
$193.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$204.25
|
| Rate for Payer: Three Rivers Provider Network All |
$161.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.95
|
| Rate for Payer: Zelis Auto |
$86.00
|
|
|
IMPLT SCREW 2.5 CORTEX 22MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000658
|
|
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 2.5 CORTEX 22MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000658
|
|
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 2.5 CORTEX 24MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000659
|
|
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 2.5 CORTEX 24MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000659
|
|
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,2.5,CORTEX,30MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000660
|
|
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,2.5,CORTEX,30MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000660
|
|
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 2.5 CORTEX LOCKING 10MM
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$676.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$591.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 10MM
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.25 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$676.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Humana ChoiceCare |
$219.70
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$507.00
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$743.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$211.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$422.50
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 14MM
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$446.40
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 14MM
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 16MM
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$446.40
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 16MM
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 18MM
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 18MM
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$446.40
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 20MM
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.25 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$676.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Humana ChoiceCare |
$219.70
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$507.00
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$743.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$211.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$422.50
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 20MM
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 20MM
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$676.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$591.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 20MM
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$446.40
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 22MM
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.25 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$676.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Humana ChoiceCare |
$219.70
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$507.00
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$743.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$211.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$422.50
|
|
|
IMPLT SCREW 2.5 CORTEX LOCKING 22MM
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$676.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cash Price |
$507.00
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: First Health Commercial |
$760.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$760.50
|
| Rate for Payer: GEHA Commercial |
$591.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$760.50
|
| Rate for Payer: Multiplan All |
$768.95
|
| Rate for Payer: OMNI Networks Commercial |
$591.50
|
| Rate for Payer: One Health Plan PPO/POS |
$760.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$802.75
|
| Rate for Payer: Three Rivers Provider Network All |
$633.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$785.85
|
| Rate for Payer: Zelis Auto |
$338.00
|
|
