|
IMPLT SCREW CORTEX 2.7X16MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000872
|
|
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 CORTEX 2.7X16MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000872
|
|
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 CORTEX 2.7X20MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000873
|
|
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 CORTEX 2.7X20MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000873
|
|
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 CORTEX 2.7X22MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000874
|
|
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 CORTEX 2.7X22MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000874
|
|
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 CORTEX 2.7X24MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000888
|
|
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 CORTEX 2.7X24MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000888
|
|
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 CORTEX 2.7X26MM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$214.40
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$187.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: Zelis Auto |
$107.20
|
|
|
IMPLT SCREW CORTEX 2.7X26MM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$214.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Humana ChoiceCare |
$69.68
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$160.80
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$235.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$134.00
|
|
|
IMPLT SCREW CORTEX 2.7X28MM
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$252.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
|
|
IMPLT SCREW CORTEX 2.7X28MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000875
|
|
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 CORTEX 2.7X28MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000875
|
|
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 CORTEX 2.7X28MM
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$252.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Humana ChoiceCare |
$81.90
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$189.00
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$277.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$78.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$157.50
|
|
|
IMPLT SCREW CORTEX 2.7X30MM
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.60 |
| Max. Negotiated Rate |
$2,065.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,739.20
|
| Rate for Payer: Cash Price |
$1,304.40
|
| Rate for Payer: Cash Price |
$1,304.40
|
| Rate for Payer: Cigna Commercial |
$1,847.90
|
| Rate for Payer: First Health Commercial |
$1,956.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,956.60
|
| Rate for Payer: GEHA Commercial |
$1,521.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,956.60
|
| Rate for Payer: Multiplan All |
$1,978.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,521.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,956.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,065.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,630.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,021.82
|
| Rate for Payer: Zelis Auto |
$869.60
|
|
|
IMPLT SCREW CORTEX 2.7X30MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000876
|
|
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 CORTEX 2.7X30MM
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.50 |
| Max. Negotiated Rate |
$2,065.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,304.40
|
| Rate for Payer: Cash Price |
$1,304.40
|
| Rate for Payer: Cash Price |
$1,304.40
|
| Rate for Payer: Cigna Commercial |
$1,847.90
|
| Rate for Payer: First Health Commercial |
$1,956.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,956.60
|
| Rate for Payer: GEHA Commercial |
$1,739.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,956.60
|
| Rate for Payer: Humana ChoiceCare |
$565.24
|
| Rate for Payer: Multiplan All |
$1,978.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,304.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,521.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,956.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,065.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,630.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,913.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$543.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,021.82
|
| Rate for Payer: Zelis Auto |
$869.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,087.00
|
|
|
IMPLT SCREW CORTEX 2.7X30MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000876
|
|
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 CORTEX 2.7X32MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000870
|
|
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 CORTEX 2.7X32MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000870
|
|
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 CORTEX 2.7X34MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000877
|
|
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 CORTEX 2.7X34MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000877
|
|
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 CORTEX 2.7X36MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000878
|
|
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 CORTEX 2.7X36MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000878
|
|
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 CORTEX 2.7X38MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000879
|
|
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
|
|
