|
IMPLT SCREW CORT 3.5X12 S-TAPPING
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000528
|
|
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 CORT 3.5X12 S-TAPPING
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000528
|
|
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 CORTEX 1.5/2.0MM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW CORTEX 1.5/2.0MM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW CORTEX 1.5MM
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006519
|
|
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 CORTEX 1.5MM
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006519
|
|
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 CORTEX 2.0X10MM
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$72.80
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$168.00
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$246.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$140.00
|
|
|
IMPLT SCREW CORTEX 2.0X10MM
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$224.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
|
|
IMPLT SCREW CORTEX 2.0X12MM
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$72.80
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$168.00
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$246.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$140.00
|
|
|
IMPLT SCREW CORTEX 2.0X12MM
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$224.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
|
|
IMPLT SCREW CORTEX 2.0X14MM
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$72.80
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$168.00
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$246.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$140.00
|
|
|
IMPLT SCREW CORTEX 2.0X14MM
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$224.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
|
|
IMPLT SCREW CORTEX 2.0X16MM
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$273.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| Rate for Payer: Humana ChoiceCare |
$88.92
|
| Rate for Payer: Multiplan All |
$311.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$205.20
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$324.90
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$300.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$85.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.06
|
| Rate for Payer: Zelis Auto |
$136.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$171.00
|
|
|
IMPLT SCREW CORTEX 2.0X16MM
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$273.60
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$239.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| Rate for Payer: Multiplan All |
$311.22
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$324.90
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.06
|
| Rate for Payer: Zelis Auto |
$136.80
|
|
|
IMPLT SCREW CORTEX 2.0X18MM
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$273.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| Rate for Payer: Humana ChoiceCare |
$88.92
|
| Rate for Payer: Multiplan All |
$311.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$205.20
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$324.90
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$300.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$85.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.06
|
| Rate for Payer: Zelis Auto |
$136.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$171.00
|
|
|
IMPLT SCREW CORTEX 2.0X18MM
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$273.60
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$239.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| Rate for Payer: Multiplan All |
$311.22
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$324.90
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.06
|
| Rate for Payer: Zelis Auto |
$136.80
|
|
|
IMPLT SCREW CORTEX 2.0X20MM
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$224.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
|
|
IMPLT SCREW CORTEX 2.0X20MM
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$72.80
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$168.00
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$246.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$140.00
|
|
|
IMPLT SCREW CORTEX 2.0X6MM
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$224.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
|
|
IMPLT SCREW CORTEX 2.0X6MM
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$72.80
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$168.00
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$246.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$140.00
|
|
|
IMPLT SCREW CORTEX 2.0X8MM
|
Facility
|
IP
|
$9,434.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,773.60 |
| Max. Negotiated Rate |
$8,962.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,547.20
|
| Rate for Payer: Cash Price |
$5,660.40
|
| Rate for Payer: Cash Price |
$5,660.40
|
| Rate for Payer: Cigna Commercial |
$8,018.90
|
| Rate for Payer: First Health Commercial |
$8,490.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,490.60
|
| Rate for Payer: GEHA Commercial |
$6,603.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,490.60
|
| Rate for Payer: Multiplan All |
$8,584.94
|
| Rate for Payer: OMNI Networks Commercial |
$6,603.80
|
| Rate for Payer: One Health Plan PPO/POS |
$8,490.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,962.30
|
| Rate for Payer: Three Rivers Provider Network All |
$7,075.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,773.62
|
| Rate for Payer: Zelis Auto |
$3,773.60
|
|
|
IMPLT SCREW CORTEX 2.0X8MM
|
Facility
|
OP
|
$9,434.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,358.50 |
| Max. Negotiated Rate |
$8,962.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,660.40
|
| Rate for Payer: Cash Price |
$5,660.40
|
| Rate for Payer: Cash Price |
$5,660.40
|
| Rate for Payer: Cigna Commercial |
$8,018.90
|
| Rate for Payer: First Health Commercial |
$8,490.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,490.60
|
| Rate for Payer: GEHA Commercial |
$7,547.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,490.60
|
| Rate for Payer: Humana ChoiceCare |
$2,452.84
|
| Rate for Payer: Multiplan All |
$8,584.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,660.40
|
| Rate for Payer: OMNI Networks Commercial |
$6,603.80
|
| Rate for Payer: One Health Plan PPO/POS |
$8,490.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,962.30
|
| Rate for Payer: Three Rivers Provider Network All |
$7,075.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,301.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,358.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,773.62
|
| Rate for Payer: Zelis Auto |
$3,773.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,717.00
|
|
|
IMPLT SCREW CORTEX 2.5MMX12MM
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$176.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$187.00
|
| Rate for Payer: First Health Commercial |
$198.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.00
|
| Rate for Payer: GEHA Commercial |
$154.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.00
|
| Rate for Payer: Multiplan All |
$200.20
|
| Rate for Payer: OMNI Networks Commercial |
$154.00
|
| Rate for Payer: One Health Plan PPO/POS |
$198.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.00
|
| Rate for Payer: Three Rivers Provider Network All |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$204.60
|
| Rate for Payer: Zelis Auto |
$88.00
|
|
|
IMPLT SCREW CORTEX 2.5MMX12MM
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$187.00
|
| Rate for Payer: First Health Commercial |
$198.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.00
|
| Rate for Payer: GEHA Commercial |
$176.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.00
|
| Rate for Payer: Humana ChoiceCare |
$57.20
|
| Rate for Payer: Multiplan All |
$200.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$132.00
|
| Rate for Payer: OMNI Networks Commercial |
$154.00
|
| Rate for Payer: One Health Plan PPO/POS |
$198.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.00
|
| Rate for Payer: Three Rivers Provider Network All |
$165.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$193.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$204.60
|
| Rate for Payer: Zelis Auto |
$88.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$110.00
|
|
|
IMPLT SCREW CORTEX 2.5X14MM
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$506.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$453.05
|
| Rate for Payer: First Health Commercial |
$479.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$479.70
|
| Rate for Payer: GEHA Commercial |
$426.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$479.70
|
| Rate for Payer: Humana ChoiceCare |
$138.58
|
| Rate for Payer: Multiplan All |
$485.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$319.80
|
| Rate for Payer: OMNI Networks Commercial |
$373.10
|
| Rate for Payer: One Health Plan PPO/POS |
$479.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$506.35
|
| Rate for Payer: Three Rivers Provider Network All |
$399.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$469.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$133.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$495.69
|
| Rate for Payer: Zelis Auto |
$213.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$266.50
|
|
