|
IMPLT SCR SN PERILOC 7X16
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.80
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: First Health Commercial |
$171.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$171.90
|
| Rate for Payer: GEHA Commercial |
$133.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$171.90
|
| Rate for Payer: Multiplan All |
$173.81
|
| Rate for Payer: OMNI Networks Commercial |
$133.70
|
| Rate for Payer: One Health Plan PPO/POS |
$171.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$181.45
|
| Rate for Payer: Three Rivers Provider Network All |
$143.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$177.63
|
| Rate for Payer: Zelis Auto |
$76.40
|
|
|
IMPLT SCR SYN CORTEX S/T 3.5X18MM
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001251
|
|
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 SCR SYN CORTEX S/T 3.5X18MM
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001251
|
|
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 SCRW 2.4X32MM TI CORTEX
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$478.40
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cigna Commercial |
$508.30
|
| Rate for Payer: First Health Commercial |
$538.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$538.20
|
| Rate for Payer: GEHA Commercial |
$418.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$538.20
|
| Rate for Payer: Multiplan All |
$544.18
|
| Rate for Payer: OMNI Networks Commercial |
$418.60
|
| Rate for Payer: One Health Plan PPO/POS |
$538.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$568.10
|
| Rate for Payer: Three Rivers Provider Network All |
$448.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$556.14
|
| Rate for Payer: Zelis Auto |
$239.20
|
|
|
IMPLT SCRW 2.4X32MM TI CORTEX
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cigna Commercial |
$508.30
|
| Rate for Payer: First Health Commercial |
$538.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$538.20
|
| Rate for Payer: GEHA Commercial |
$478.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$538.20
|
| Rate for Payer: Humana ChoiceCare |
$155.48
|
| Rate for Payer: Multiplan All |
$544.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$358.80
|
| Rate for Payer: OMNI Networks Commercial |
$418.60
|
| Rate for Payer: One Health Plan PPO/POS |
$538.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$568.10
|
| Rate for Payer: Three Rivers Provider Network All |
$448.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$526.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$149.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$556.14
|
| Rate for Payer: Zelis Auto |
$239.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$299.00
|
|
|
IMPLT SCRW 2.4X36MM TI CORTEX
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cigna Commercial |
$508.30
|
| Rate for Payer: First Health Commercial |
$538.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$538.20
|
| Rate for Payer: GEHA Commercial |
$478.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$538.20
|
| Rate for Payer: Humana ChoiceCare |
$155.48
|
| Rate for Payer: Multiplan All |
$544.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$358.80
|
| Rate for Payer: OMNI Networks Commercial |
$418.60
|
| Rate for Payer: One Health Plan PPO/POS |
$538.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$568.10
|
| Rate for Payer: Three Rivers Provider Network All |
$448.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$526.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$149.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$556.14
|
| Rate for Payer: Zelis Auto |
$239.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$299.00
|
|
|
IMPLT SCRW 2.4X36MM TI CORTEX
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$478.40
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cigna Commercial |
$508.30
|
| Rate for Payer: First Health Commercial |
$538.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$538.20
|
| Rate for Payer: GEHA Commercial |
$418.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$538.20
|
| Rate for Payer: Multiplan All |
$544.18
|
| Rate for Payer: OMNI Networks Commercial |
$418.60
|
| Rate for Payer: One Health Plan PPO/POS |
$538.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$568.10
|
| Rate for Payer: Three Rivers Provider Network All |
$448.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$556.14
|
| Rate for Payer: Zelis Auto |
$239.20
|
|
|
IMPLT SCRW 2.4X38MM TI CORTEX
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cigna Commercial |
$508.30
|
| Rate for Payer: First Health Commercial |
$538.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$538.20
|
| Rate for Payer: GEHA Commercial |
$478.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$538.20
|
| Rate for Payer: Humana ChoiceCare |
$155.48
|
| Rate for Payer: Multiplan All |
$544.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$358.80
|
| Rate for Payer: OMNI Networks Commercial |
$418.60
|
| Rate for Payer: One Health Plan PPO/POS |
$538.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$568.10
|
| Rate for Payer: Three Rivers Provider Network All |
$448.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$526.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$149.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$556.14
|
| Rate for Payer: Zelis Auto |
$239.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$299.00
|
|
|
IMPLT SCRW 2.4X38MM TI CORTEX
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$478.40
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cigna Commercial |
$508.30
|
| Rate for Payer: First Health Commercial |
$538.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$538.20
|
| Rate for Payer: GEHA Commercial |
$418.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$538.20
|
| Rate for Payer: Multiplan All |
$544.18
|
| Rate for Payer: OMNI Networks Commercial |
$418.60
|
| Rate for Payer: One Health Plan PPO/POS |
$538.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$568.10
|
| Rate for Payer: Three Rivers Provider Network All |
$448.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$556.14
|
| Rate for Payer: Zelis Auto |
$239.20
|
|
|
IMPLT SCRW 2.4X40MM TI CORTEX
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cigna Commercial |
$508.30
|
| Rate for Payer: First Health Commercial |
$538.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$538.20
|
| Rate for Payer: GEHA Commercial |
$478.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$538.20
|
| Rate for Payer: Humana ChoiceCare |
$155.48
|
| Rate for Payer: Multiplan All |
$544.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$358.80
|
| Rate for Payer: OMNI Networks Commercial |
$418.60
|
| Rate for Payer: One Health Plan PPO/POS |
$538.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$568.10
|
| Rate for Payer: Three Rivers Provider Network All |
$448.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$526.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$149.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$556.14
|
| Rate for Payer: Zelis Auto |
$239.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$299.00
|
|
|
IMPLT SCRW 2.4X40MM TI CORTEX
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$478.40
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cigna Commercial |
$508.30
|
| Rate for Payer: First Health Commercial |
$538.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$538.20
|
| Rate for Payer: GEHA Commercial |
$418.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$538.20
|
| Rate for Payer: Multiplan All |
$544.18
|
| Rate for Payer: OMNI Networks Commercial |
$418.60
|
| Rate for Payer: One Health Plan PPO/POS |
$538.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$568.10
|
| Rate for Payer: Three Rivers Provider Network All |
$448.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$556.14
|
| Rate for Payer: Zelis Auto |
$239.20
|
|
|
IMPLT SCRW 2.5X10MM LOCK CORTEX
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
|
|
IMPLT SCRW 2.5X10MM LOCK CORTEX
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$446.40
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
|
|
IMPLT SCRW 2.5X12MM LOCK CORTEX
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
|
|
IMPLT SCRW 2.5X12MM LOCK CORTEX
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$446.40
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
|
|
IMPLT SCRW 2.5X14MM LOCK CORTEX
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
|
|
IMPLT SCRW 2.5X14MM LOCK CORTEX
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$446.40
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
|
|
IMPLT SCRW 2.5X16MM LOCK CORTEX
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$81.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
|
|
IMPLT SCRW 2.5X16MM LOCK CORTEX
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
|
|
IMPLT SCRW 2.5X16MM LOCK CORTEX
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.20
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.00
|
|
|
IMPLT SCRW 2.5X16MM LOCK CORTEX
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$446.40
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
|
|
IMPLT SCRW 2.5X18MM LOCK CORTEX
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
|
|
IMPLT SCRW 2.5X18MM LOCK CORTEX
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$446.40
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
|
|
IMPLT SCRW 3.5X16MM PERI-LOCK CORTEX
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$934.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$590.40
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$836.40
|
| Rate for Payer: First Health Commercial |
$885.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$885.60
|
| Rate for Payer: GEHA Commercial |
$787.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$885.60
|
| Rate for Payer: Humana ChoiceCare |
$255.84
|
| Rate for Payer: Multiplan All |
$895.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$590.40
|
| Rate for Payer: OMNI Networks Commercial |
$688.80
|
| Rate for Payer: One Health Plan PPO/POS |
$885.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$934.80
|
| Rate for Payer: Three Rivers Provider Network All |
$738.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$865.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$915.12
|
| Rate for Payer: Zelis Auto |
$393.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$492.00
|
|
|
IMPLT SCRW 3.5X16MM PERI-LOCK CORTEX
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.60 |
| Max. Negotiated Rate |
$934.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$787.20
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$836.40
|
| Rate for Payer: First Health Commercial |
$885.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$885.60
|
| Rate for Payer: GEHA Commercial |
$688.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$885.60
|
| Rate for Payer: Multiplan All |
$895.44
|
| Rate for Payer: OMNI Networks Commercial |
$688.80
|
| Rate for Payer: One Health Plan PPO/POS |
$885.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$934.80
|
| Rate for Payer: Three Rivers Provider Network All |
$738.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$915.12
|
| Rate for Payer: Zelis Auto |
$393.60
|
|
