|
IMPLT SCREW 4.0X50MM
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$844.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$738.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
|
|
IMPLT SCREW 4.0X50MM
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$775.20
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$678.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
|
|
IMPLT SCREW 4.0X50MM FULLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$84.24
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$194.40
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$285.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.00
|
|
|
IMPLT SCREW 4.0X50MM FULLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
|
|
IMPLT SCREW 4.0X50MM PARTIALLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
|
|
IMPLT SCREW 4.0X50MM PARTIALLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$84.24
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$194.40
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$285.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.00
|
|
|
IMPLT SCREW 4.0 X 55MM
|
Facility
|
OP
|
$1,809.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.25 |
| Max. Negotiated Rate |
$1,718.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,085.40
|
| Rate for Payer: Cash Price |
$1,085.40
|
| Rate for Payer: Cash Price |
$1,085.40
|
| Rate for Payer: Cigna Commercial |
$1,537.65
|
| Rate for Payer: First Health Commercial |
$1,628.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,628.10
|
| Rate for Payer: GEHA Commercial |
$1,447.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,628.10
|
| Rate for Payer: Humana ChoiceCare |
$470.34
|
| Rate for Payer: Multiplan All |
$1,646.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,085.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,266.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,628.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,718.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,356.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,591.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$452.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,682.37
|
| Rate for Payer: Zelis Auto |
$723.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$904.50
|
|
|
IMPLT SCREW 4.0 X 55MM
|
Facility
|
IP
|
$1,809.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7007034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$723.60 |
| Max. Negotiated Rate |
$1,718.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,447.20
|
| Rate for Payer: Cash Price |
$1,085.40
|
| Rate for Payer: Cash Price |
$1,085.40
|
| Rate for Payer: Cigna Commercial |
$1,537.65
|
| Rate for Payer: First Health Commercial |
$1,628.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,628.10
|
| Rate for Payer: GEHA Commercial |
$1,266.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,628.10
|
| Rate for Payer: Multiplan All |
$1,646.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,266.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,628.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,718.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,356.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,682.37
|
| Rate for Payer: Zelis Auto |
$723.60
|
|
|
IMPLT SCREW 4.0X55MM
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Humana ChoiceCare |
$235.56
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.60
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$797.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.00
|
|
|
IMPLT SCREW 4.0X55MM
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
|
|
IMPLT SCREW 4.0X55MM FULLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$84.24
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$194.40
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$285.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.00
|
|
|
IMPLT SCREW 4.0X55MM FULLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
|
|
IMPLT SCREW 4.0X55MM PARTIALLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$84.24
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$194.40
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$285.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.00
|
|
|
IMPLT SCREW 4.0X55MM PARTIALLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
|
|
IMPLT SCREW 4.0X60MM FULLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$84.24
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$194.40
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$285.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.00
|
|
|
IMPLT SCREW 4.0X60MM FULLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$84.24
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$194.40
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$285.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.00
|
|
|
IMPLT SCREW 4.0X60MM FULLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
|
|
IMPLT SCREW 4.0X60MM FULLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
|
|
IMPLT SCREW 4.0X60MM PARTIALLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$84.24
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$194.40
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$285.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.00
|
|
|
IMPLT SCREW 4.0X60MM PARTIALLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
|
|
IMPLT SCREW 4.0X65MM FULLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
|
|
IMPLT SCREW 4.0X65MM FULLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$84.24
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$194.40
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$285.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.00
|
|
|
IMPLT SCREW 4.0X65MM PARTIALLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$84.24
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$194.40
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$285.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.00
|
|
|
IMPLT SCREW 4.0X65MM PARTIALLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
|
|
IMPLT SCREW 4.0X70MM FULLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$84.24
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$194.40
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$285.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$162.00
|
|
