|
IMPLT SCREW CORTEX CORTICAL TI 3.5X20MM
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$79.30
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.00
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$268.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.50
|
|
|
IMPLT SCREW CORTEX CORTICAL TI 3.5X20MM
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
|
|
IMPLT SCREW CORTEX LOCKING 2.5X10MM
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.60 |
| Max. Negotiated Rate |
$550.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$463.20
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$405.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$538.47
|
| Rate for Payer: Zelis Auto |
$231.60
|
|
|
IMPLT SCREW CORTEX LOCKING 2.5X10MM
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.75 |
| Max. Negotiated Rate |
$550.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$463.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| Rate for Payer: Humana ChoiceCare |
$150.54
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$347.40
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$509.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$144.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$538.47
|
| Rate for Payer: Zelis Auto |
$231.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$289.50
|
|
|
IMPLT SCREW CORTEX LOCKING 2.5X12MM
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: First Health Commercial |
$540.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$540.00
|
| Rate for Payer: GEHA Commercial |
$480.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$540.00
|
| Rate for Payer: Humana ChoiceCare |
$156.00
|
| Rate for Payer: Multiplan All |
$546.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$360.00
|
| Rate for Payer: OMNI Networks Commercial |
$420.00
|
| Rate for Payer: One Health Plan PPO/POS |
$540.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$570.00
|
| Rate for Payer: Three Rivers Provider Network All |
$450.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$528.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$558.00
|
| Rate for Payer: Zelis Auto |
$240.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$300.00
|
|
|
IMPLT SCREW CORTEX LOCKING 2.5X12MM
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$480.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: First Health Commercial |
$540.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$540.00
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$540.00
|
| Rate for Payer: Multiplan All |
$546.00
|
| Rate for Payer: OMNI Networks Commercial |
$420.00
|
| Rate for Payer: One Health Plan PPO/POS |
$540.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$570.00
|
| Rate for Payer: Three Rivers Provider Network All |
$450.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$558.00
|
| Rate for Payer: Zelis Auto |
$240.00
|
|
|
IMPLT SCREW CORTEX LOCKING 2.5X14MM
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: First Health Commercial |
$540.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$540.00
|
| Rate for Payer: GEHA Commercial |
$480.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$540.00
|
| Rate for Payer: Humana ChoiceCare |
$156.00
|
| Rate for Payer: Multiplan All |
$546.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$360.00
|
| Rate for Payer: OMNI Networks Commercial |
$420.00
|
| Rate for Payer: One Health Plan PPO/POS |
$540.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$570.00
|
| Rate for Payer: Three Rivers Provider Network All |
$450.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$528.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$558.00
|
| Rate for Payer: Zelis Auto |
$240.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$300.00
|
|
|
IMPLT SCREW CORTEX LOCKING 2.5X14MM
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$480.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: First Health Commercial |
$540.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$540.00
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$540.00
|
| Rate for Payer: Multiplan All |
$546.00
|
| Rate for Payer: OMNI Networks Commercial |
$420.00
|
| Rate for Payer: One Health Plan PPO/POS |
$540.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$570.00
|
| Rate for Payer: Three Rivers Provider Network All |
$450.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$558.00
|
| Rate for Payer: Zelis Auto |
$240.00
|
|
|
IMPLT SCREW CORTEX,LOCKING 2.5X20MM
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
|
|
IMPLT SCREW CORTEX,LOCKING 2.5X20MM
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$446.40
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
|
|
IMPLT SCREW CORTEX LOCKING 3.5X14MM
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$660.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$590.75
|
| Rate for Payer: First Health Commercial |
$625.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$625.50
|
| Rate for Payer: GEHA Commercial |
$486.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$625.50
|
| Rate for Payer: Multiplan All |
$632.45
|
| Rate for Payer: OMNI Networks Commercial |
$486.50
|
| Rate for Payer: One Health Plan PPO/POS |
$625.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$660.25
|
| Rate for Payer: Three Rivers Provider Network All |
$521.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$646.35
|
| Rate for Payer: Zelis Auto |
$278.00
|
|
|
IMPLT SCREW CORTEX LOCKING 3.5X14MM
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$173.75 |
| Max. Negotiated Rate |
$660.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$590.75
|
| Rate for Payer: First Health Commercial |
$625.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$625.50
|
| Rate for Payer: GEHA Commercial |
$556.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$625.50
|
| Rate for Payer: Humana ChoiceCare |
$180.70
|
| Rate for Payer: Multiplan All |
$632.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$417.00
|
| Rate for Payer: OMNI Networks Commercial |
$486.50
|
| Rate for Payer: One Health Plan PPO/POS |
$625.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$660.25
|
| Rate for Payer: Three Rivers Provider Network All |
$521.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$611.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$173.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$646.35
|
| Rate for Payer: Zelis Auto |
$278.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$347.50
|
|
|
IMPLT SCREW CORTEX LOCKING 3.5X14MM
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.80 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$385.60
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$337.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
|
|
IMPLT SCREW CORTEX LOCKING 3.5X14MM
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$385.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Humana ChoiceCare |
$125.32
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$289.20
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$424.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$120.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$241.00
|
|
|
IMPLT SCREW CORTEX LOCKING 3.5X16MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$121.42
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$280.20
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$410.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.50
|
|
|
IMPLT SCREW CORTEX LOCKING 3.5X16MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.60
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
|
|
IMPLT SCREW CORTEX LOCKING 3.5X18MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$373.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Humana ChoiceCare |
$121.42
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$280.20
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$410.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.50
|
|
|
IMPLT SCREW CORTEX LOCKING 3.5X18MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.60
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
|
|
IMPLT SCREW CORTEX SELF TAP 2.0X10MM
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$282.40
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$247.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| Rate for Payer: Multiplan All |
$321.23
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.35
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.29
|
| Rate for Payer: Zelis Auto |
$141.20
|
|
|
IMPLT SCREW CORTEX SELF TAP 2.0X10MM
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.25 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$282.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| Rate for Payer: Humana ChoiceCare |
$91.78
|
| Rate for Payer: Multiplan All |
$321.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$211.80
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.35
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$310.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$88.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.29
|
| Rate for Payer: Zelis Auto |
$141.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$176.50
|
|
|
IMPLT SCREW CORTEX SELF TAP 24MM
|
Facility
|
OP
|
$1,022.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.50 |
| Max. Negotiated Rate |
$970.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$868.70
|
| Rate for Payer: First Health Commercial |
$919.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$919.80
|
| Rate for Payer: GEHA Commercial |
$817.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$919.80
|
| Rate for Payer: Humana ChoiceCare |
$265.72
|
| Rate for Payer: Multiplan All |
$930.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$613.20
|
| Rate for Payer: OMNI Networks Commercial |
$715.40
|
| Rate for Payer: One Health Plan PPO/POS |
$919.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$970.90
|
| Rate for Payer: Three Rivers Provider Network All |
$766.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$899.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$255.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$950.46
|
| Rate for Payer: Zelis Auto |
$408.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$511.00
|
|
|
IMPLT SCREW CORTEX SELF TAP 24MM
|
Facility
|
IP
|
$1,022.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.80 |
| Max. Negotiated Rate |
$970.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$817.60
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$868.70
|
| Rate for Payer: First Health Commercial |
$919.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$919.80
|
| Rate for Payer: GEHA Commercial |
$715.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$919.80
|
| Rate for Payer: Multiplan All |
$930.02
|
| Rate for Payer: OMNI Networks Commercial |
$715.40
|
| Rate for Payer: One Health Plan PPO/POS |
$919.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$970.90
|
| Rate for Payer: Three Rivers Provider Network All |
$766.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$950.46
|
| Rate for Payer: Zelis Auto |
$408.80
|
|
|
IMPLT SCREW CORTEX SELF TAP 2.5X10MM
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$180.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Humana ChoiceCare |
$58.76
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$135.60
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$198.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: Zelis Auto |
$90.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$113.00
|
|
|
IMPLT SCREW CORTEX SELF TAP 2.5X10MM
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.80
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$158.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: Zelis Auto |
$90.40
|
|
|
IMPLT SCREW CORTEX SELF TAP 2.5X18MM
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: First Health Commercial |
$193.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$193.50
|
| Rate for Payer: GEHA Commercial |
$150.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$193.50
|
| Rate for Payer: Multiplan All |
$195.65
|
| Rate for Payer: OMNI Networks Commercial |
$150.50
|
| Rate for Payer: One Health Plan PPO/POS |
$193.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$204.25
|
| Rate for Payer: Three Rivers Provider Network All |
$161.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.95
|
| Rate for Payer: Zelis Auto |
$86.00
|
|
