|
IMPLT HEADED SCREW 4.0MM X 24MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009134
|
|
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 4.0MM X 26MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009135
|
|
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 4.0MM X 26MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009135
|
|
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 4.0MM X 28MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009136
|
|
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 4.0MM X 28MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009136
|
|
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 4.0MM X 30MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009137
|
|
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 4.0MM X 30MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009137
|
|
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 4.0MM X 32MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009138
|
|
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 4.0MM X 32MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009138
|
|
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 4.0MM X 34MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009139
|
|
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 4.0MM X 34MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009139
|
|
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 4.0MM X 36MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009140
|
|
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 4.0MM X 36MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009140
|
|
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 4.0MM X 38MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007037
|
|
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 4.0MM X 38MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007037
|
|
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 4.0MM X 40MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009141
|
|
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 4.0MM X 40MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009141
|
|
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 4.0MM X 42MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009142
|
|
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 4.0MM X 42MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009142
|
|
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 4.0MM X 44MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009143
|
|
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 4.0MM X 44MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009143
|
|
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 4.0MM X 46MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009144
|
|
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 4.0MM X 46MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009144
|
|
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 4.0MM X 48MM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009145
|
|
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 4.0MM X 48MM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009145
|
|
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
|
|
