|
IMPLT SCREW CORTEX SELFTAP 4.5X40MM
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000830
|
|
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 SELFTAP 4.5X40MM
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000830
|
|
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 SELF TAPPING 3.5X20MM
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000829
|
|
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 TAPPING 3.5X20MM
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000829
|
|
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 SFTAP 1.5X8MM
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.60
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$186.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
|
|
IMPLT SCREW CORTEX SFTAP 1.5X8MM
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$213.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Humana ChoiceCare |
$69.42
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$160.20
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$234.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$133.50
|
|
|
IMPLT SCREW CORTEX SFTAP 2X10MM
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$217.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Humana ChoiceCare |
$70.72
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$163.20
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$239.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$68.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: Zelis Auto |
$108.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$136.00
|
|
|
IMPLT SCREW CORTEX SFTAP 2X10MM
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$190.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: Zelis Auto |
$108.80
|
|
|
IMPLT SCREW CORTEX SFTAP 2X14
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$190.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: Zelis Auto |
$108.80
|
|
|
IMPLT SCREW CORTEX SFTAP 2X14
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$217.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Humana ChoiceCare |
$70.72
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$163.20
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$239.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$68.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: Zelis Auto |
$108.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$136.00
|
|
|
IMPLT SCREW CORTEX SFTAP 2X8MM
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$190.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: Zelis Auto |
$108.80
|
|
|
IMPLT SCREW CORTEX SFTAP 2X8MM
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$217.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Humana ChoiceCare |
$70.72
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$163.20
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$239.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$68.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: Zelis Auto |
$108.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$136.00
|
|
|
IMPLT SCREW CORTEX ST 2.7MMX18MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
|
|
IMPLT SCREW CORTEX ST 2.7MMX18MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.40
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
|
|
IMPLT SCREW CORTEX S.T. 2.7X24MM
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001449
|
|
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 S.T. 2.7X24MM
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001449
|
|
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 TAP SELF14MM
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$191.25
|
| Rate for Payer: First Health Commercial |
$202.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$202.50
|
| Rate for Payer: GEHA Commercial |
$157.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$202.50
|
| Rate for Payer: Multiplan All |
$204.75
|
| Rate for Payer: OMNI Networks Commercial |
$157.50
|
| Rate for Payer: One Health Plan PPO/POS |
$202.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$213.75
|
| Rate for Payer: Three Rivers Provider Network All |
$168.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$209.25
|
| Rate for Payer: Zelis Auto |
$90.00
|
|
|
IMPLT SCREW CORTEX TAP SELF14MM
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$191.25
|
| Rate for Payer: First Health Commercial |
$202.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$202.50
|
| Rate for Payer: GEHA Commercial |
$180.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$202.50
|
| Rate for Payer: Humana ChoiceCare |
$58.50
|
| Rate for Payer: Multiplan All |
$204.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$135.00
|
| Rate for Payer: OMNI Networks Commercial |
$157.50
|
| Rate for Payer: One Health Plan PPO/POS |
$202.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$213.75
|
| Rate for Payer: Three Rivers Provider Network All |
$168.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$209.25
|
| Rate for Payer: Zelis Auto |
$90.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$112.50
|
|
|
IMPLT SCREW CORTEX TAP SELF 16MM
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cigna Commercial |
$292.40
|
| Rate for Payer: First Health Commercial |
$309.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$309.60
|
| Rate for Payer: GEHA Commercial |
$275.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$309.60
|
| Rate for Payer: Humana ChoiceCare |
$89.44
|
| Rate for Payer: Multiplan All |
$313.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$206.40
|
| Rate for Payer: OMNI Networks Commercial |
$240.80
|
| Rate for Payer: One Health Plan PPO/POS |
$309.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$326.80
|
| Rate for Payer: Three Rivers Provider Network All |
$258.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$302.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$319.92
|
| Rate for Payer: Zelis Auto |
$137.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$172.00
|
|
|
IMPLT SCREW CORTEX TAP SELF 16MM
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.60 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$275.20
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cigna Commercial |
$292.40
|
| Rate for Payer: First Health Commercial |
$309.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$309.60
|
| Rate for Payer: GEHA Commercial |
$240.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$309.60
|
| Rate for Payer: Multiplan All |
$313.04
|
| Rate for Payer: OMNI Networks Commercial |
$240.80
|
| Rate for Payer: One Health Plan PPO/POS |
$309.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$326.80
|
| Rate for Payer: Three Rivers Provider Network All |
$258.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$319.92
|
| Rate for Payer: Zelis Auto |
$137.60
|
|
|
IMPLT SCREW CORTEX TAP SELF 2.5X18MM
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000540
|
|
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 TAP SELF 2.5X18MM
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000540
|
|
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 TAP SELF 2.5X20MM
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000541
|
|
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 TAP SELF 2.5X20MM
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000541
|
|
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 TAP SELF 2.5X22MM
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000542
|
|
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
|
|
