|
IMPLT HEADED SCREW 2.5MM X 18MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 18MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 20MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 20MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 22MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 22MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 24MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 24MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 26MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 26MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 28MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 28MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 30MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 30MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 32MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 32MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.75 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,455.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Humana ChoiceCare |
$472.94
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,091.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,600.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$454.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$909.50
|
|
|
IMPLT HEADED SCREW 2.5MM X 32MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.60 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,455.20
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,273.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
|
|
IMPLT HEADED SCREW 2.5MM X 32MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 34MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 34MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 36MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.60 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,455.20
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,273.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
|
|
IMPLT HEADED SCREW 2.5MM X 36MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
|
IMPLT HEADED SCREW 2.5MM X 36MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
|
|
IMPLT HEADED SCREW 2.5MM X 36MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.75 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,455.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Humana ChoiceCare |
$472.94
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,091.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,600.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$454.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$909.50
|
|
|
IMPLT HEADED SCREW 2.5MM X 38MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
|
