|
IMPLT HEADLESS SCREW 3.0MM X 24MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009171
|
|
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 HEADLESS SCREW 3.0MM X 26MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009172
|
|
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 HEADLESS SCREW 3.0MM X 26MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009172
|
|
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 HEADLESS SCREW 3.0MM X 28MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009173
|
|
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 HEADLESS SCREW 3.0MM X 28MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009173
|
|
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 HEADLESS SCREW 3.0MM X 30MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009174
|
|
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 HEADLESS SCREW 3.0MM X 30MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009174
|
|
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 HEADLESS SCREW 3.0MM X 32MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009175
|
|
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 HEADLESS SCREW 3.0MM X 32MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009175
|
|
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 HEADLESS SCREW 3.0MM X 34MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009176
|
|
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 HEADLESS SCREW 3.0MM X 34MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009176
|
|
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 HEADLESS SCREW 3.0MM X 36MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009177
|
|
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 HEADLESS SCREW 3.0MM X 36MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009177
|
|
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 HEADLESS SCREW 3.0MM X 38MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009178
|
|
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 HEADLESS SCREW 3.0MM X 38MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009178
|
|
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 HEADLESS SCREW 3.0MM X 40MM
|
Facility
|
OP
|
$1,718.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.50 |
| Max. Negotiated Rate |
$1,632.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,030.80
|
| Rate for Payer: Cash Price |
$1,030.80
|
| Rate for Payer: Cash Price |
$1,030.80
|
| Rate for Payer: Cigna Commercial |
$1,460.30
|
| Rate for Payer: First Health Commercial |
$1,546.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,546.20
|
| Rate for Payer: GEHA Commercial |
$1,374.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,546.20
|
| Rate for Payer: Humana ChoiceCare |
$446.68
|
| Rate for Payer: Multiplan All |
$1,563.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,030.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,202.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,546.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,632.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,288.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,511.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$429.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,597.74
|
| Rate for Payer: Zelis Auto |
$687.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$859.00
|
|
|
IMPLT HEADLESS SCREW 3.0MM X 40MM
|
Facility
|
IP
|
$1,718.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.20 |
| Max. Negotiated Rate |
$1,632.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,374.40
|
| Rate for Payer: Cash Price |
$1,030.80
|
| Rate for Payer: Cash Price |
$1,030.80
|
| Rate for Payer: Cigna Commercial |
$1,460.30
|
| Rate for Payer: First Health Commercial |
$1,546.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,546.20
|
| Rate for Payer: GEHA Commercial |
$1,202.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,546.20
|
| Rate for Payer: Multiplan All |
$1,563.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,202.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,546.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,632.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,288.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,597.74
|
| Rate for Payer: Zelis Auto |
$687.20
|
|
|
IMPLT HEADLESS SCREW 3.5X 44MM
|
Facility
|
IP
|
$278.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.52 |
| Max. Negotiated Rate |
$264.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$223.04
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cigna Commercial |
$236.98
|
| Rate for Payer: First Health Commercial |
$250.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.92
|
| Rate for Payer: GEHA Commercial |
$195.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.92
|
| Rate for Payer: Multiplan All |
$253.71
|
| Rate for Payer: OMNI Networks Commercial |
$195.16
|
| Rate for Payer: One Health Plan PPO/POS |
$250.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.86
|
| Rate for Payer: Three Rivers Provider Network All |
$209.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.28
|
| Rate for Payer: Zelis Auto |
$111.52
|
|
|
IMPLT HEADLESS SCREW 3.5X 44MM
|
Facility
|
OP
|
$278.80
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$264.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.28
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cigna Commercial |
$236.98
|
| Rate for Payer: First Health Commercial |
$250.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.92
|
| Rate for Payer: GEHA Commercial |
$223.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.92
|
| Rate for Payer: Humana ChoiceCare |
$72.49
|
| Rate for Payer: Multiplan All |
$253.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$167.28
|
| Rate for Payer: OMNI Networks Commercial |
$195.16
|
| Rate for Payer: One Health Plan PPO/POS |
$250.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.86
|
| Rate for Payer: Three Rivers Provider Network All |
$209.10
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$245.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.28
|
| Rate for Payer: Zelis Auto |
$111.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$139.40
|
|
|
IMPLT HEADLESS SCREW 4.0MM X 12MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009180
|
|
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 HEADLESS SCREW 4.0MM X 12MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009180
|
|
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 HEADLESS SCREW 4.0MM X 14MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009181
|
|
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 HEADLESS SCREW 4.0MM X 14MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009181
|
|
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 HEADLESS SCREW 4.0MM X 16MM
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009182
|
|
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 HEADLESS SCREW 4.0MM X 16MM
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009182
|
|
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
|
|
