|
IMPLT SCREW CORTEX 3.5X38MM
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.40 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$216.80
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$230.35
|
| Rate for Payer: First Health Commercial |
$243.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.90
|
| Rate for Payer: GEHA Commercial |
$189.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.90
|
| Rate for Payer: Multiplan All |
$246.61
|
| Rate for Payer: OMNI Networks Commercial |
$189.70
|
| Rate for Payer: One Health Plan PPO/POS |
$243.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$257.45
|
| Rate for Payer: Three Rivers Provider Network All |
$203.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.03
|
| Rate for Payer: Zelis Auto |
$108.40
|
|
|
IMPLT SCREW CORTEX 3.5X38MM
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.75 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$230.35
|
| Rate for Payer: First Health Commercial |
$243.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.90
|
| Rate for Payer: GEHA Commercial |
$216.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.90
|
| Rate for Payer: Humana ChoiceCare |
$70.46
|
| Rate for Payer: Multiplan All |
$246.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$162.60
|
| Rate for Payer: OMNI Networks Commercial |
$189.70
|
| Rate for Payer: One Health Plan PPO/POS |
$243.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$257.45
|
| Rate for Payer: Three Rivers Provider Network All |
$203.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$238.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.03
|
| Rate for Payer: Zelis Auto |
$108.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$135.50
|
|
|
IMPLT SCREW CORTEX 3.5X40MM
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000821
|
|
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 3.5X40MM
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000821
|
|
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 3.5X44MM
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001420
|
|
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 3.5X44MM
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001420
|
|
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 3.5X50MM
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
|
|
IMPLT SCREW CORTEX 3.5X50MM
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$192.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Humana ChoiceCare |
$62.40
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.00
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$211.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.00
|
|
|
IMPLT SCREW CORTEX 3.5X55MM
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.75 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$230.35
|
| Rate for Payer: First Health Commercial |
$243.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.90
|
| Rate for Payer: GEHA Commercial |
$216.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.90
|
| Rate for Payer: Humana ChoiceCare |
$70.46
|
| Rate for Payer: Multiplan All |
$246.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$162.60
|
| Rate for Payer: OMNI Networks Commercial |
$189.70
|
| Rate for Payer: One Health Plan PPO/POS |
$243.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$257.45
|
| Rate for Payer: Three Rivers Provider Network All |
$203.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$238.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.03
|
| Rate for Payer: Zelis Auto |
$108.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$135.50
|
|
|
IMPLT SCREW CORTEX 3.5X55MM
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.40 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$216.80
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$230.35
|
| Rate for Payer: First Health Commercial |
$243.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.90
|
| Rate for Payer: GEHA Commercial |
$189.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.90
|
| Rate for Payer: Multiplan All |
$246.61
|
| Rate for Payer: OMNI Networks Commercial |
$189.70
|
| Rate for Payer: One Health Plan PPO/POS |
$243.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$257.45
|
| Rate for Payer: Three Rivers Provider Network All |
$203.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.03
|
| Rate for Payer: Zelis Auto |
$108.40
|
|
|
IMPLT SCREW CORTEX 3.5X55MM
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000823
|
|
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 3.5X55MM
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000823
|
|
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 3.5X60MM
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Humana ChoiceCare |
$63.70
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$147.00
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$215.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$61.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$122.50
|
|
|
IMPLT SCREW CORTEX 3.5X60MM
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.60
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$491.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
|
|
IMPLT SCREW CORTEX 3.5X60MM
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$192.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Humana ChoiceCare |
$62.40
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.00
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$211.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.00
|
|
|
IMPLT SCREW CORTEX 3.5X60MM
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$196.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$171.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: Zelis Auto |
$98.00
|
|
|
IMPLT SCREW CORTEX 3.5X60MM
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$561.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Humana ChoiceCare |
$182.52
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$421.20
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$617.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$175.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$351.00
|
|
|
IMPLT SCREW CORTEX 3.5X60MM
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$216.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.00
|
| Rate for Payer: Multiplan All |
$218.40
|
| Rate for Payer: OMNI Networks Commercial |
$168.00
|
| Rate for Payer: One Health Plan PPO/POS |
$216.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.00
|
| Rate for Payer: Three Rivers Provider Network All |
$180.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$223.20
|
| Rate for Payer: Zelis Auto |
$96.00
|
|
|
IMPLT SCREW CORTEX 4.0X36MM
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$236.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Humana ChoiceCare |
$76.96
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$177.60
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$260.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: Zelis Auto |
$118.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$148.00
|
|
|
IMPLT SCREW CORTEX 4.0X36MM
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$236.80
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: Zelis Auto |
$118.40
|
|
|
IMPLT SCREW CORTEX 4.0X40MM
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$236.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Humana ChoiceCare |
$76.96
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$177.60
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$260.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: Zelis Auto |
$118.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$148.00
|
|
|
IMPLT SCREW CORTEX 4.0X40MM
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$236.80
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: Zelis Auto |
$118.40
|
|
|
IMPLT SCREW CORTEX 4.5MMX42
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.25 |
| Max. Negotiated Rate |
$893.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$799.85
|
| Rate for Payer: First Health Commercial |
$846.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.90
|
| Rate for Payer: GEHA Commercial |
$752.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.90
|
| Rate for Payer: Humana ChoiceCare |
$244.66
|
| Rate for Payer: Multiplan All |
$856.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$564.60
|
| Rate for Payer: OMNI Networks Commercial |
$658.70
|
| Rate for Payer: One Health Plan PPO/POS |
$846.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.95
|
| Rate for Payer: Three Rivers Provider Network All |
$705.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$235.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$875.13
|
| Rate for Payer: Zelis Auto |
$376.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$470.50
|
|
|
IMPLT SCREW CORTEX 4.5MMX42
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$376.40 |
| Max. Negotiated Rate |
$893.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$752.80
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$799.85
|
| Rate for Payer: First Health Commercial |
$846.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.90
|
| Rate for Payer: GEHA Commercial |
$658.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.90
|
| Rate for Payer: Multiplan All |
$856.31
|
| Rate for Payer: OMNI Networks Commercial |
$658.70
|
| Rate for Payer: One Health Plan PPO/POS |
$846.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.95
|
| Rate for Payer: Three Rivers Provider Network All |
$705.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$875.13
|
| Rate for Payer: Zelis Auto |
$376.40
|
|
|
IMPLT SCREW CORTEX 4.5MMX60
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$376.40 |
| Max. Negotiated Rate |
$893.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$752.80
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$799.85
|
| Rate for Payer: First Health Commercial |
$846.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.90
|
| Rate for Payer: GEHA Commercial |
$658.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.90
|
| Rate for Payer: Multiplan All |
$856.31
|
| Rate for Payer: OMNI Networks Commercial |
$658.70
|
| Rate for Payer: One Health Plan PPO/POS |
$846.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.95
|
| Rate for Payer: Three Rivers Provider Network All |
$705.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$875.13
|
| Rate for Payer: Zelis Auto |
$376.40
|
|
