|
IMPLT SCREW BONE THREAD FULL 2.4MMX16MM
|
Facility
|
IP
|
$528.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.36 |
| Max. Negotiated Rate |
$501.98 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$422.72
|
| Rate for Payer: Cash Price |
$317.04
|
| Rate for Payer: Cash Price |
$317.04
|
| Rate for Payer: Cigna Commercial |
$449.14
|
| Rate for Payer: First Health Commercial |
$475.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.56
|
| Rate for Payer: GEHA Commercial |
$369.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.56
|
| Rate for Payer: Multiplan All |
$480.84
|
| Rate for Payer: OMNI Networks Commercial |
$369.88
|
| Rate for Payer: One Health Plan PPO/POS |
$475.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.98
|
| Rate for Payer: Three Rivers Provider Network All |
$396.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.41
|
| Rate for Payer: Zelis Auto |
$211.36
|
|
|
IMPLT SCREW BONE THREAD FULL 2.4MMX16MM
|
Facility
|
OP
|
$528.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.10 |
| Max. Negotiated Rate |
$501.98 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$317.04
|
| Rate for Payer: Cash Price |
$317.04
|
| Rate for Payer: Cash Price |
$317.04
|
| Rate for Payer: Cigna Commercial |
$449.14
|
| Rate for Payer: First Health Commercial |
$475.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.56
|
| Rate for Payer: GEHA Commercial |
$422.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.56
|
| Rate for Payer: Humana ChoiceCare |
$137.38
|
| Rate for Payer: Multiplan All |
$480.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$317.04
|
| Rate for Payer: OMNI Networks Commercial |
$369.88
|
| Rate for Payer: One Health Plan PPO/POS |
$475.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.98
|
| Rate for Payer: Three Rivers Provider Network All |
$396.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$464.99
|
| Rate for Payer: United Healthcare Managed Medicaid |
$132.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.41
|
| Rate for Payer: Zelis Auto |
$211.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.20
|
|
|
IMPLT SCREW BONE THREAD FULL 2.4MMX18MM
|
Facility
|
IP
|
$528.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.36 |
| Max. Negotiated Rate |
$501.98 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$422.72
|
| Rate for Payer: Cash Price |
$317.04
|
| Rate for Payer: Cash Price |
$317.04
|
| Rate for Payer: Cigna Commercial |
$449.14
|
| Rate for Payer: First Health Commercial |
$475.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.56
|
| Rate for Payer: GEHA Commercial |
$369.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.56
|
| Rate for Payer: Multiplan All |
$480.84
|
| Rate for Payer: OMNI Networks Commercial |
$369.88
|
| Rate for Payer: One Health Plan PPO/POS |
$475.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.98
|
| Rate for Payer: Three Rivers Provider Network All |
$396.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.41
|
| Rate for Payer: Zelis Auto |
$211.36
|
|
|
IMPLT SCREW BONE THREAD FULL 2.4MMX18MM
|
Facility
|
OP
|
$528.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.10 |
| Max. Negotiated Rate |
$501.98 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$317.04
|
| Rate for Payer: Cash Price |
$317.04
|
| Rate for Payer: Cash Price |
$317.04
|
| Rate for Payer: Cigna Commercial |
$449.14
|
| Rate for Payer: First Health Commercial |
$475.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.56
|
| Rate for Payer: GEHA Commercial |
$422.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.56
|
| Rate for Payer: Humana ChoiceCare |
$137.38
|
| Rate for Payer: Multiplan All |
$480.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$317.04
|
| Rate for Payer: OMNI Networks Commercial |
$369.88
|
| Rate for Payer: One Health Plan PPO/POS |
$475.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.98
|
| Rate for Payer: Three Rivers Provider Network All |
$396.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$464.99
|
| Rate for Payer: United Healthcare Managed Medicaid |
$132.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.41
|
| Rate for Payer: Zelis Auto |
$211.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.20
|
|
|
IMPLT SCREW BONE THREAD FULL 2.4MMX20MM
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$252.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
|
|
IMPLT SCREW BONE THREAD FULL 2.4MMX20MM
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: First Health Commercial |
$283.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$283.50
|
| Rate for Payer: GEHA Commercial |
$252.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$283.50
|
| Rate for Payer: Humana ChoiceCare |
$81.90
|
| Rate for Payer: Multiplan All |
$286.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$189.00
|
| Rate for Payer: OMNI Networks Commercial |
$220.50
|
| Rate for Payer: One Health Plan PPO/POS |
$283.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$299.25
|
| Rate for Payer: Three Rivers Provider Network All |
$236.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$277.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$78.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$292.95
|
| Rate for Payer: Zelis Auto |
$126.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$157.50
|
|
|
IMPLT SCREW BONE THREAD FULL 2.7MMX10MM
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.40 |
| Max. Negotiated Rate |
$509.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$428.80
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cigna Commercial |
$455.60
|
| Rate for Payer: First Health Commercial |
$482.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.40
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.40
|
| Rate for Payer: Multiplan All |
$487.76
|
| Rate for Payer: OMNI Networks Commercial |
$375.20
|
| Rate for Payer: One Health Plan PPO/POS |
$482.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.20
|
| Rate for Payer: Three Rivers Provider Network All |
$402.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.48
|
| Rate for Payer: Zelis Auto |
$214.40
|
|
|
IMPLT SCREW BONE THREAD FULL 2.7MMX10MM
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$509.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cigna Commercial |
$455.60
|
| Rate for Payer: First Health Commercial |
$482.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.40
|
| Rate for Payer: GEHA Commercial |
$428.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.40
|
| Rate for Payer: Humana ChoiceCare |
$139.36
|
| Rate for Payer: Multiplan All |
$487.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$321.60
|
| Rate for Payer: OMNI Networks Commercial |
$375.20
|
| Rate for Payer: One Health Plan PPO/POS |
$482.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.20
|
| Rate for Payer: Three Rivers Provider Network All |
$402.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$471.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$134.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.48
|
| Rate for Payer: Zelis Auto |
$214.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$268.00
|
|
|
IMPLT SCREW BONE THREAD FULL 2.7MMX12MM
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.40 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.80
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$399.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
|
|
IMPLT SCREW BONE THREAD FULL 2.7MMX12MM
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.75 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$456.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Humana ChoiceCare |
$148.46
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$342.60
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$502.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$285.50
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX10MM
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$470.40
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$411.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX10MM
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$470.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Humana ChoiceCare |
$152.88
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$352.80
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$517.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$294.00
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX12MM
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.40 |
| Max. Negotiated Rate |
$509.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$428.80
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cigna Commercial |
$455.60
|
| Rate for Payer: First Health Commercial |
$482.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.40
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.40
|
| Rate for Payer: Multiplan All |
$487.76
|
| Rate for Payer: OMNI Networks Commercial |
$375.20
|
| Rate for Payer: One Health Plan PPO/POS |
$482.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.20
|
| Rate for Payer: Three Rivers Provider Network All |
$402.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.48
|
| Rate for Payer: Zelis Auto |
$214.40
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX12MM
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.40 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.80
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: Zelis Auto |
$278.40
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX12MM
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$509.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cigna Commercial |
$455.60
|
| Rate for Payer: First Health Commercial |
$482.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.40
|
| Rate for Payer: GEHA Commercial |
$428.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.40
|
| Rate for Payer: Humana ChoiceCare |
$139.36
|
| Rate for Payer: Multiplan All |
$487.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$321.60
|
| Rate for Payer: OMNI Networks Commercial |
$375.20
|
| Rate for Payer: One Health Plan PPO/POS |
$482.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.20
|
| Rate for Payer: Three Rivers Provider Network All |
$402.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$471.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$134.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.48
|
| Rate for Payer: Zelis Auto |
$214.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$268.00
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX12MM
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$556.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Humana ChoiceCare |
$180.96
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$417.60
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$612.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$174.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$348.00
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX14MM
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.80 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$441.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$386.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX14MM
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$441.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Humana ChoiceCare |
$143.52
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$331.20
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$485.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$138.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$276.00
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX16MM
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$470.40
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$411.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX16MM
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$470.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Humana ChoiceCare |
$152.88
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$352.80
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$517.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$294.00
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX18MM
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$470.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Humana ChoiceCare |
$152.88
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$352.80
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$517.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$294.00
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX18MM
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$470.40
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$411.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX20MM
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$441.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Humana ChoiceCare |
$143.52
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$331.20
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$485.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$138.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$276.00
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX20MM
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.80 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$441.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$386.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
|
|
IMPLT SCREW BONE THREAD FULL 3.5MMX22MM
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$470.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Humana ChoiceCare |
$152.88
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$352.80
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$517.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$294.00
|
|
