|
IMPLT SCREW CORTEX 2.7X38MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000879
|
|
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 2.7X40MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000880
|
|
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 2.7X40MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000880
|
|
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 2.7X42MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000881
|
|
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 2.7X42MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000881
|
|
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 2.7X44MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000882
|
|
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 2.7X44MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000882
|
|
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 2.7X46MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000883
|
|
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 2.7X46MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000883
|
|
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 2.7X48MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000884
|
|
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 2.7X48MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000884
|
|
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 2.7X50MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000885
|
|
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 2.7X50MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000885
|
|
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 2.7X60MM
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
|
|
IMPLT SCREW CORTEX 2.7X60MM
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000886
|
|
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 CORTEX 2.7X60MM
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000886
|
|
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 CORTEX 2.7X60MM
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$49.92
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$115.20
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$96.00
|
|
|
IMPLT SCREW CORTEX 2.7X65MM
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000836
|
|
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 CORTEX 2.7X65MM
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000836
|
|
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 CORTEX 2.7X6MM
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002520
|
|
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 2.7X6MM
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002520
|
|
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 2.7X70MM
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000887
|
|
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 CORTEX 2.7X70MM
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000887
|
|
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 CORTEX 2.7X8MM
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002521
|
|
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 2.7X8MM
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002521
|
|
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
|
|
