|
IMPLT SCREW LOCK 4.5X32MM
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$467.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Humana ChoiceCare |
$151.84
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$350.40
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$513.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$146.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$292.00
|
|
|
IMPLT SCREW LOCK 4.5X34MM
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$467.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Humana ChoiceCare |
$151.84
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$350.40
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$513.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$146.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$292.00
|
|
|
IMPLT SCREW LOCK 4.5X34MM
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$467.20
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$408.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
|
|
IMPLT SCREW LOCK 4.5X36MM
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.60 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$851.20
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$744.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
|
|
IMPLT SCREW LOCK 4.5X36MM
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Humana ChoiceCare |
$276.64
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$638.40
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$936.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$532.00
|
|
|
IMPLT SCREW LOCK 4.5X38MM
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.60 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$851.20
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$744.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
|
|
IMPLT SCREW LOCK 4.5X38MM
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Humana ChoiceCare |
$276.64
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$638.40
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$936.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$532.00
|
|
|
IMPLT SCREW LOCK 4.5X40MM
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$467.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Humana ChoiceCare |
$151.84
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$350.40
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$513.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$146.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$292.00
|
|
|
IMPLT SCREW LOCK 4.5X40MM
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$467.20
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$408.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
|
|
IMPLT SCREW LOCK 4.5X42MM
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.60 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$851.20
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$744.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
|
|
IMPLT SCREW LOCK 4.5X42MM
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$1,010.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$904.40
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$957.60
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$957.60
|
| Rate for Payer: Humana ChoiceCare |
$276.64
|
| Rate for Payer: Multiplan All |
$968.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$638.40
|
| Rate for Payer: OMNI Networks Commercial |
$744.80
|
| Rate for Payer: One Health Plan PPO/POS |
$957.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,010.80
|
| Rate for Payer: Three Rivers Provider Network All |
$798.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$936.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$989.52
|
| Rate for Payer: Zelis Auto |
$425.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$532.00
|
|
|
IMPLT SCREW LOCK 4.5X44MM
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$467.20
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$408.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
|
|
IMPLT SCREW LOCK 4.5X44MM
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$467.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Humana ChoiceCare |
$151.84
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$350.40
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$513.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$146.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$292.00
|
|
|
IMPLT SCREW LOCK 5.0X50MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW LOCK 5.0X50MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW LOCK 5X40MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$830.40
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
|
|
IMPLT SCREW LOCK 5X40MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$269.88
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$622.80
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$913.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$259.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$519.00
|
|
|
IMPLT SCREW LOCKABLE HEX 2.3X16MM
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$465.80
|
| Rate for Payer: First Health Commercial |
$493.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.20
|
| Rate for Payer: GEHA Commercial |
$438.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.20
|
| Rate for Payer: Humana ChoiceCare |
$142.48
|
| Rate for Payer: Multiplan All |
$498.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$328.80
|
| Rate for Payer: OMNI Networks Commercial |
$383.60
|
| Rate for Payer: One Health Plan PPO/POS |
$493.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$520.60
|
| Rate for Payer: Three Rivers Provider Network All |
$411.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$482.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$509.64
|
| Rate for Payer: Zelis Auto |
$219.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$274.00
|
|
|
IMPLT SCREW LOCKABLE HEX 2.3X16MM
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$438.40
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$465.80
|
| Rate for Payer: First Health Commercial |
$493.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.20
|
| Rate for Payer: GEHA Commercial |
$383.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.20
|
| Rate for Payer: Multiplan All |
$498.68
|
| Rate for Payer: OMNI Networks Commercial |
$383.60
|
| Rate for Payer: One Health Plan PPO/POS |
$493.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$520.60
|
| Rate for Payer: Three Rivers Provider Network All |
$411.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$509.64
|
| Rate for Payer: Zelis Auto |
$219.20
|
|
|
IMPLT SCREW LOCKING 05X50MM PAR THREADED
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna Commercial |
$902.70
|
| Rate for Payer: First Health Commercial |
$955.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$955.80
|
| Rate for Payer: GEHA Commercial |
$849.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$955.80
|
| Rate for Payer: Humana ChoiceCare |
$276.12
|
| Rate for Payer: Multiplan All |
$966.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$637.20
|
| Rate for Payer: OMNI Networks Commercial |
$743.40
|
| Rate for Payer: One Health Plan PPO/POS |
$955.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,008.90
|
| Rate for Payer: Three Rivers Provider Network All |
$796.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$934.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$265.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$987.66
|
| Rate for Payer: Zelis Auto |
$424.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$531.00
|
|
|
IMPLT SCREW LOCKING 05X50MM PAR THREADED
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.80 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$849.60
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna Commercial |
$902.70
|
| Rate for Payer: First Health Commercial |
$955.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$955.80
|
| Rate for Payer: GEHA Commercial |
$743.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$955.80
|
| Rate for Payer: Multiplan All |
$966.42
|
| Rate for Payer: OMNI Networks Commercial |
$743.40
|
| Rate for Payer: One Health Plan PPO/POS |
$955.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,008.90
|
| Rate for Payer: Three Rivers Provider Network All |
$796.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$987.66
|
| Rate for Payer: Zelis Auto |
$424.80
|
|
|
IMPLT SCREW LOCKING 05X65MM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW LOCKING 05X65MM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW LOCKING,05X70MM
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000937
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.40 |
| Max. Negotiated Rate |
$931.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$784.80
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cigna Commercial |
$833.85
|
| Rate for Payer: First Health Commercial |
$882.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$882.90
|
| Rate for Payer: GEHA Commercial |
$686.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$882.90
|
| Rate for Payer: Multiplan All |
$892.71
|
| Rate for Payer: OMNI Networks Commercial |
$686.70
|
| Rate for Payer: One Health Plan PPO/POS |
$882.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$931.95
|
| Rate for Payer: Three Rivers Provider Network All |
$735.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$912.33
|
| Rate for Payer: Zelis Auto |
$392.40
|
|
|
IMPLT SCREW LOCKING,05X70MM
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000937
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.25 |
| Max. Negotiated Rate |
$931.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cigna Commercial |
$833.85
|
| Rate for Payer: First Health Commercial |
$882.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$882.90
|
| Rate for Payer: GEHA Commercial |
$784.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$882.90
|
| Rate for Payer: Humana ChoiceCare |
$255.06
|
| Rate for Payer: Multiplan All |
$892.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.60
|
| Rate for Payer: OMNI Networks Commercial |
$686.70
|
| Rate for Payer: One Health Plan PPO/POS |
$882.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$931.95
|
| Rate for Payer: Three Rivers Provider Network All |
$735.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$863.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$245.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$912.33
|
| Rate for Payer: Zelis Auto |
$392.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$490.50
|
|
