|
IMPLT SCREW CORTEX TAP SELF 2.5X22MM
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000542
|
|
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 2.7X16MM
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$229.60
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
|
|
IMPLT SCREW CORTEX TAP SELF 2.7X16MM
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.75 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Humana ChoiceCare |
$74.62
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$172.20
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$252.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$143.50
|
|
|
IMPLT SCREW CORTEX TAP SELF 2.7X6MM
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006586
|
|
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 TAP SELF 2.7X6MM
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006586
|
|
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 TAP SELF 2.7X8MM
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: First Health Commercial |
$315.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.00
|
| Rate for Payer: GEHA Commercial |
$280.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.00
|
| Rate for Payer: Humana ChoiceCare |
$91.00
|
| Rate for Payer: Multiplan All |
$318.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$210.00
|
| Rate for Payer: OMNI Networks Commercial |
$245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$315.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.50
|
| Rate for Payer: Three Rivers Provider Network All |
$262.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$308.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$87.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.50
|
| Rate for Payer: Zelis Auto |
$140.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$175.00
|
|
|
IMPLT SCREW CORTEX TAP SELF 2.7X8MM
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: First Health Commercial |
$315.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.00
|
| Rate for Payer: GEHA Commercial |
$245.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.00
|
| Rate for Payer: Multiplan All |
$318.50
|
| Rate for Payer: OMNI Networks Commercial |
$245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$315.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.50
|
| Rate for Payer: Three Rivers Provider Network All |
$262.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.50
|
| Rate for Payer: Zelis Auto |
$140.00
|
|
|
IMPLT SCREW CORTEX TAP SELF 4.5X46MM
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002478
|
|
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 TAP SELF 4.5X46MM
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002478
|
|
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 TAP SELF 6MM
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002529
|
|
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 6MM
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002529
|
|
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 THREADED 3.5X14MM
|
Facility
|
IP
|
$689.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$654.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$551.20
|
| Rate for Payer: Cash Price |
$413.40
|
| Rate for Payer: Cash Price |
$413.40
|
| Rate for Payer: Cigna Commercial |
$585.65
|
| Rate for Payer: First Health Commercial |
$620.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$620.10
|
| Rate for Payer: GEHA Commercial |
$482.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$620.10
|
| Rate for Payer: Multiplan All |
$626.99
|
| Rate for Payer: OMNI Networks Commercial |
$482.30
|
| Rate for Payer: One Health Plan PPO/POS |
$620.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$654.55
|
| Rate for Payer: Three Rivers Provider Network All |
$516.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$640.77
|
| Rate for Payer: Zelis Auto |
$275.60
|
|
|
IMPLT SCREW CORTEX THREADED 3.5X14MM
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.25 |
| Max. Negotiated Rate |
$654.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$413.40
|
| Rate for Payer: Cash Price |
$413.40
|
| Rate for Payer: Cash Price |
$413.40
|
| Rate for Payer: Cigna Commercial |
$585.65
|
| Rate for Payer: First Health Commercial |
$620.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$620.10
|
| Rate for Payer: GEHA Commercial |
$551.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$620.10
|
| Rate for Payer: Humana ChoiceCare |
$179.14
|
| Rate for Payer: Multiplan All |
$626.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$413.40
|
| Rate for Payer: OMNI Networks Commercial |
$482.30
|
| Rate for Payer: One Health Plan PPO/POS |
$620.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$654.55
|
| Rate for Payer: Three Rivers Provider Network All |
$516.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$606.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$172.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$640.77
|
| Rate for Payer: Zelis Auto |
$275.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$344.50
|
|
|
IMPLT SCREW CORTEX THREADED FULLY 3.5MM
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.20
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$146.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
|
|
IMPLT SCREW CORTEX THREADED FULLY 3.5MM
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.25 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$167.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Humana ChoiceCare |
$54.34
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$125.40
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$183.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$52.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.50
|
|
|
IMPLT SCREW CORTEX THREADED FULLY 3.5X24
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.20
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$146.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
|
|
IMPLT SCREW CORTEX THREADED FULLY 3.5X24
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.25 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$167.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Humana ChoiceCare |
$54.34
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$125.40
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$183.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$52.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.50
|
|
|
IMPLT SCREW CORTEX THREADED FULLY 3.5X26
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.25 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$167.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Humana ChoiceCare |
$54.34
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$125.40
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$183.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$52.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.50
|
|
|
IMPLT SCREW CORTEX THREADED FULLY 3.5X26
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.20
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$146.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
|
|
IMPLT SCREW CORTEX THREADED FULLY 3.5X28
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.25 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$167.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Humana ChoiceCare |
$54.34
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$125.40
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$183.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$52.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.50
|
|
|
IMPLT SCREW CORTEX THREADED FULLY 3.5X28
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.20
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$146.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
|
|
IMPLT SCREW CORTEX TITANIUM 2.4X24MM
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$520.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Humana ChoiceCare |
$169.00
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.00
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$572.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$162.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: Zelis Auto |
$260.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$325.00
|
|
|
IMPLT SCREW CORTEX TITANIUM 2.4X24MM
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$520.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$455.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: Zelis Auto |
$260.00
|
|
|
IMPLT SCREW CORTEX TITANIUM 2.4X26MM
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$520.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Humana ChoiceCare |
$169.00
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.00
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$572.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$162.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: Zelis Auto |
$260.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$325.00
|
|
|
IMPLT SCREW CORTEX TITANIUM 2.4X26MM
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$520.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$455.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: Zelis Auto |
$260.00
|
|
