|
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
|
|
|
IMPLT SCREW 4.0X70MM FULLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001714
|
|
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
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002830
|
|
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 PARTIALLY THREADED
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001777
|
|
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 4.0X70MM PARTIALLY THREADED
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001777
|
|
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 4.5X32MM
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$87.36
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.60
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.00
|
|
|
IMPLT SCREW 4.5X32MM
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
|
|
IMPLT SCREW 4.5X34MM CORTICAL
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$87.36
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.60
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.00
|
|
|
IMPLT SCREW 4.5X34MM CORTICAL
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
|
|
IMPLT SCREW 4.5X36MM CORTICAL
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
|
|
IMPLT SCREW 4.5X36MM CORTICAL
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$87.36
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.60
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.00
|
|
|
IMPLT SCREW 48MM FRAG SMALL
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$704.80
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$616.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
|
|
IMPLT SCREW 48MM FRAG SMALL
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$704.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Humana ChoiceCare |
$229.06
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$528.60
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$775.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$440.50
|
|
|
IMPLT SCREW 50MM FRAG SMALL
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$704.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Humana ChoiceCare |
$229.06
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$528.60
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$775.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$440.50
|
|
|
IMPLT SCREW 50MM FRAG SMALL
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$704.80
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$616.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
|
|
IMPLT SCREW 5.0X30MM
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.25 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$238.42
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$550.20
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$806.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$229.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$458.50
|
|
|
IMPLT SCREW 5.0X30MM
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.60
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
|
|
IMPLT SCREW 5.0X34MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW 5.0X34MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW 5.0X34MM
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.25 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$238.42
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$550.20
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$806.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$229.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$458.50
|
|
|
IMPLT SCREW 5.0X34MM
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.60
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
|
|
IMPLT SCREW 5.0X46MM
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.25 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$238.42
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$550.20
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$806.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$229.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$458.50
|
|
|
IMPLT SCREW 5.0X46MM
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.60
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
|
|
IMPLT SCREW 5.0X50MM
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.60
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
|
|
IMPLT SCREW 5.0X50MM
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.25 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$238.42
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$550.20
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$806.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$229.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$458.50
|
|
