|
IMPLT SCREW CORTEX 4.5MMX60
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000533
|
|
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 4.5MMX62
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000534
|
|
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 4.5MMX62
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000534
|
|
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 4.5X20MM
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001423
|
|
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 4.5X20MM
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001423
|
|
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 4.5X22MM
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001424
|
|
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 4.5X22MM
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001424
|
|
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 4.5X26MM
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001425
|
|
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 4.5X26MM
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001425
|
|
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 4.5X28MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$216.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$189.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| Rate for Payer: Multiplan All |
$245.70
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$256.50
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$251.10
|
| Rate for Payer: Zelis Auto |
$108.00
|
|
|
IMPLT SCREW CORTEX 4.5X28MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$216.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| Rate for Payer: Humana ChoiceCare |
$70.20
|
| Rate for Payer: Multiplan All |
$245.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$162.00
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$256.50
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$237.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$251.10
|
| Rate for Payer: Zelis Auto |
$108.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$135.00
|
|
|
IMPLT SCREW CORTEX 4.5X30MM
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.25 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Humana ChoiceCare |
$121.94
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$281.40
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$412.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$234.50
|
|
|
IMPLT SCREW CORTEX 4.5X30MM
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.20
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$328.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
|
|
IMPLT SCREW CORTEX 4.5X38MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$216.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| Rate for Payer: Humana ChoiceCare |
$70.20
|
| Rate for Payer: Multiplan All |
$245.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$162.00
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$256.50
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$237.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$251.10
|
| Rate for Payer: Zelis Auto |
$108.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$135.00
|
|
|
IMPLT SCREW CORTEX 4.5X38MM
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000535
|
|
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 4.5X38MM
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000535
|
|
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 4.5X38MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$216.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$189.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| Rate for Payer: Multiplan All |
$245.70
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$256.50
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$251.10
|
| Rate for Payer: Zelis Auto |
$108.00
|
|
|
IMPLT SCREW CORTEX 4.5X44MM
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000536
|
|
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 4.5X44MM
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000536
|
|
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 4.5X50MM
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002479
|
|
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 4.5X50MM
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002479
|
|
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 4.5X60MM
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000537
|
|
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 4.5X60MM
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000537
|
|
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 46 X 4.5MM
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$176.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
|
|
IMPLT SCREW CORTEX 46 X 4.5MM
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Humana ChoiceCare |
$65.52
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$151.20
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$221.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$126.00
|
|
