|
IMPLT SCREW CORTEX SELF TAP 2.5X18MM
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$129.00
|
| 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 |
$172.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$193.50
|
| Rate for Payer: Humana ChoiceCare |
$55.90
|
| Rate for Payer: Multiplan All |
$195.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$129.00
|
| 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: TriWest Veterans Administration/VAPC3 |
$189.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.95
|
| Rate for Payer: Zelis Auto |
$86.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.50
|
|
|
IMPLT SCREW CORTEX SELFTAP 2.5X22MM
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$129.00
|
| 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 |
$172.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$193.50
|
| Rate for Payer: Humana ChoiceCare |
$55.90
|
| Rate for Payer: Multiplan All |
$195.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$129.00
|
| 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: TriWest Veterans Administration/VAPC3 |
$189.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$199.95
|
| Rate for Payer: Zelis Auto |
$86.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$107.50
|
|
|
IMPLT SCREW CORTEX SELFTAP 2.5X22MM
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000853
|
|
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
|
|
|
IMPLT SCREW CORTEX SELF TAP 2.7X14MM
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$276.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Humana ChoiceCare |
$89.70
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$207.00
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$303.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$172.50
|
|
|
IMPLT SCREW CORTEX SELF TAP 2.7X14MM
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$276.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: First Health Commercial |
$310.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$310.50
|
| Rate for Payer: GEHA Commercial |
$241.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$310.50
|
| Rate for Payer: Multiplan All |
$313.95
|
| Rate for Payer: OMNI Networks Commercial |
$241.50
|
| Rate for Payer: One Health Plan PPO/POS |
$310.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$327.75
|
| Rate for Payer: Three Rivers Provider Network All |
$258.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$320.85
|
| Rate for Payer: Zelis Auto |
$138.00
|
|
|
IMPLT SCREW CORTEX SELF TAP 2.7X16MM
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.75 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$210.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Humana ChoiceCare |
$68.38
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$157.80
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$231.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$131.50
|
|
|
IMPLT SCREW CORTEX SELF TAP 2.7X16MM
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$210.40
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$184.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
|
|
IMPLT SCREW CORTEX SELF TAP 2.7X22MM
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$173.60
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$151.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: Zelis Auto |
$86.80
|
|
|
IMPLT SCREW CORTEX SELF TAP 2.7X22MM
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.25 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Humana ChoiceCare |
$56.42
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$130.20
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$190.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$54.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$108.50
|
|
|
IMPLT SCREW CORTEX SELFTAP 3.5X10MM
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$224.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
|
|
IMPLT SCREW CORTEX SELFTAP 3.5X10MM
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$72.80
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$168.00
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$246.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$140.00
|
|
|
IMPLT SCREW CORTEX SELFTAP 3.5X12MM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000545
|
|
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 SELFTAP 3.5X12MM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000545
|
|
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 3.5X14MM
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.50 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$175.10
|
| Rate for Payer: First Health Commercial |
$185.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$185.40
|
| Rate for Payer: GEHA Commercial |
$164.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$185.40
|
| Rate for Payer: Humana ChoiceCare |
$53.56
|
| Rate for Payer: Multiplan All |
$187.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$123.60
|
| Rate for Payer: OMNI Networks Commercial |
$144.20
|
| Rate for Payer: One Health Plan PPO/POS |
$185.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$195.70
|
| Rate for Payer: Three Rivers Provider Network All |
$154.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$181.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$191.58
|
| Rate for Payer: Zelis Auto |
$82.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$103.00
|
|
|
IMPLT SCREW CORTEX SELF TAP 3.5X14MM
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$88.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$77.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
|
|
IMPLT SCREW CORTEX SELF TAP 3.5X14MM
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$88.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Humana ChoiceCare |
$28.60
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$66.00
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$96.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$55.00
|
|
|
IMPLT SCREW CORTEX SELF TAP 3.5X14MM
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$164.80
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$175.10
|
| Rate for Payer: First Health Commercial |
$185.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$185.40
|
| Rate for Payer: GEHA Commercial |
$144.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$185.40
|
| Rate for Payer: Multiplan All |
$187.46
|
| Rate for Payer: OMNI Networks Commercial |
$144.20
|
| Rate for Payer: One Health Plan PPO/POS |
$185.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$195.70
|
| Rate for Payer: Three Rivers Provider Network All |
$154.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$191.58
|
| Rate for Payer: Zelis Auto |
$82.40
|
|
|
IMPLT SCREW CORTEX SELF TAP3.5X16MM
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$210.40
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$184.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
|
|
IMPLT SCREW CORTEX SELF TAP3.5X16MM
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.75 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$210.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Humana ChoiceCare |
$68.38
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$157.80
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$231.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$131.50
|
|
|
IMPLT SCREW CORTEX SELF TAP 3.5X18MM
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.75 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$210.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Humana ChoiceCare |
$68.38
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$157.80
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$231.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$131.50
|
|
|
IMPLT SCREW CORTEX SELF TAP 3.5X18MM
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$210.40
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$223.55
|
| Rate for Payer: First Health Commercial |
$236.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$236.70
|
| Rate for Payer: GEHA Commercial |
$184.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$236.70
|
| Rate for Payer: Multiplan All |
$239.33
|
| Rate for Payer: OMNI Networks Commercial |
$184.10
|
| Rate for Payer: One Health Plan PPO/POS |
$236.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$249.85
|
| Rate for Payer: Three Rivers Provider Network All |
$197.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$244.59
|
| Rate for Payer: Zelis Auto |
$105.20
|
|
|
IMPLT SCREW CORTEX SELF TAP 3.5X20MM
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.25 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$183.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Humana ChoiceCare |
$59.54
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$137.40
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$201.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.50
|
|
|
IMPLT SCREW CORTEX SELF TAP 3.5X20MM
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.20
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$194.65
|
| Rate for Payer: First Health Commercial |
$206.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$206.10
|
| Rate for Payer: GEHA Commercial |
$160.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$206.10
|
| Rate for Payer: Multiplan All |
$208.39
|
| Rate for Payer: OMNI Networks Commercial |
$160.30
|
| Rate for Payer: One Health Plan PPO/POS |
$206.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$217.55
|
| Rate for Payer: Three Rivers Provider Network All |
$171.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.97
|
| Rate for Payer: Zelis Auto |
$91.60
|
|
|
IMPLT SCREW CORTEX SELF TAP 3.5X20MM
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
|
|
IMPLT SCREW CORTEX SELF TAP 3.5X20MM
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
|
