|
IMPLT SCREW LOCKING 3.5X8MM
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.80 |
| Max. Negotiated Rate |
$842.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$709.60
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$753.95
|
| Rate for Payer: First Health Commercial |
$798.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.30
|
| Rate for Payer: GEHA Commercial |
$620.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.30
|
| Rate for Payer: Multiplan All |
$807.17
|
| Rate for Payer: OMNI Networks Commercial |
$620.90
|
| Rate for Payer: One Health Plan PPO/POS |
$798.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.65
|
| Rate for Payer: Three Rivers Provider Network All |
$665.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$824.91
|
| Rate for Payer: Zelis Auto |
$354.80
|
|
|
IMPLT SCREW LOCKING 3.5X8MM
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.75 |
| Max. Negotiated Rate |
$842.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$753.95
|
| Rate for Payer: First Health Commercial |
$798.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.30
|
| Rate for Payer: GEHA Commercial |
$709.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.30
|
| Rate for Payer: Humana ChoiceCare |
$230.62
|
| Rate for Payer: Multiplan All |
$807.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$532.20
|
| Rate for Payer: OMNI Networks Commercial |
$620.90
|
| Rate for Payer: One Health Plan PPO/POS |
$798.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.65
|
| Rate for Payer: Three Rivers Provider Network All |
$665.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$780.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$221.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$824.91
|
| Rate for Payer: Zelis Auto |
$354.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$443.50
|
|
|
IMPLT SCREW LOCKING 4.0MM 371518
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.25 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cigna Commercial |
$769.25
|
| Rate for Payer: First Health Commercial |
$814.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$814.50
|
| Rate for Payer: GEHA Commercial |
$724.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$814.50
|
| Rate for Payer: Humana ChoiceCare |
$235.30
|
| Rate for Payer: Multiplan All |
$823.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.00
|
| Rate for Payer: OMNI Networks Commercial |
$633.50
|
| Rate for Payer: One Health Plan PPO/POS |
$814.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$859.75
|
| Rate for Payer: Three Rivers Provider Network All |
$678.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$796.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$841.65
|
| Rate for Payer: Zelis Auto |
$362.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$452.50
|
|
|
IMPLT SCREW LOCKING 4.0MM 371518
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.00 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cigna Commercial |
$769.25
|
| Rate for Payer: First Health Commercial |
$814.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$814.50
|
| Rate for Payer: GEHA Commercial |
$633.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$814.50
|
| Rate for Payer: Multiplan All |
$823.55
|
| Rate for Payer: OMNI Networks Commercial |
$633.50
|
| Rate for Payer: One Health Plan PPO/POS |
$814.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$859.75
|
| Rate for Payer: Three Rivers Provider Network All |
$678.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$841.65
|
| Rate for Payer: Zelis Auto |
$362.00
|
|
|
IMPLT SCREW LOCKING 4.0 X 14MM
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.00 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cigna Commercial |
$769.25
|
| Rate for Payer: First Health Commercial |
$814.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$814.50
|
| Rate for Payer: GEHA Commercial |
$633.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$814.50
|
| Rate for Payer: Multiplan All |
$823.55
|
| Rate for Payer: OMNI Networks Commercial |
$633.50
|
| Rate for Payer: One Health Plan PPO/POS |
$814.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$859.75
|
| Rate for Payer: Three Rivers Provider Network All |
$678.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$841.65
|
| Rate for Payer: Zelis Auto |
$362.00
|
|
|
IMPLT SCREW LOCKING 4.0 X 14MM
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.25 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cigna Commercial |
$769.25
|
| Rate for Payer: First Health Commercial |
$814.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$814.50
|
| Rate for Payer: GEHA Commercial |
$724.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$814.50
|
| Rate for Payer: Humana ChoiceCare |
$235.30
|
| Rate for Payer: Multiplan All |
$823.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$543.00
|
| Rate for Payer: OMNI Networks Commercial |
$633.50
|
| Rate for Payer: One Health Plan PPO/POS |
$814.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$859.75
|
| Rate for Payer: Three Rivers Provider Network All |
$678.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$796.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$841.65
|
| Rate for Payer: Zelis Auto |
$362.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$452.50
|
|
|
IMPLT SCREW LOCKING 4.0X16MM
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$737.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$659.60
|
| Rate for Payer: First Health Commercial |
$698.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$698.40
|
| Rate for Payer: GEHA Commercial |
$620.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$698.40
|
| Rate for Payer: Humana ChoiceCare |
$201.76
|
| Rate for Payer: Multiplan All |
$706.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$465.60
|
| Rate for Payer: OMNI Networks Commercial |
$543.20
|
| Rate for Payer: One Health Plan PPO/POS |
$698.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$737.20
|
| Rate for Payer: Three Rivers Provider Network All |
$582.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$682.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$194.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$721.68
|
| Rate for Payer: Zelis Auto |
$310.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$388.00
|
|
|
IMPLT SCREW LOCKING 4.0X16MM
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.40 |
| Max. Negotiated Rate |
$737.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$620.80
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$659.60
|
| Rate for Payer: First Health Commercial |
$698.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$698.40
|
| Rate for Payer: GEHA Commercial |
$543.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$698.40
|
| Rate for Payer: Multiplan All |
$706.16
|
| Rate for Payer: OMNI Networks Commercial |
$543.20
|
| Rate for Payer: One Health Plan PPO/POS |
$698.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$737.20
|
| Rate for Payer: Three Rivers Provider Network All |
$582.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$721.68
|
| Rate for Payer: Zelis Auto |
$310.40
|
|
|
IMPLT SCREW LOCKING 4.0X20MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$797.60
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$697.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
|
|
IMPLT SCREW LOCKING 4.0X20MM
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$737.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$659.60
|
| Rate for Payer: First Health Commercial |
$698.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$698.40
|
| Rate for Payer: GEHA Commercial |
$620.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$698.40
|
| Rate for Payer: Humana ChoiceCare |
$201.76
|
| Rate for Payer: Multiplan All |
$706.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$465.60
|
| Rate for Payer: OMNI Networks Commercial |
$543.20
|
| Rate for Payer: One Health Plan PPO/POS |
$698.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$737.20
|
| Rate for Payer: Three Rivers Provider Network All |
$582.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$682.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$194.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$721.68
|
| Rate for Payer: Zelis Auto |
$310.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$388.00
|
|
|
IMPLT SCREW LOCKING 4.0X20MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Humana ChoiceCare |
$259.22
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$598.20
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$877.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$249.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.50
|
|
|
IMPLT SCREW LOCKING 4.0X20MM
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.40 |
| Max. Negotiated Rate |
$737.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$620.80
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$659.60
|
| Rate for Payer: First Health Commercial |
$698.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$698.40
|
| Rate for Payer: GEHA Commercial |
$543.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$698.40
|
| Rate for Payer: Multiplan All |
$706.16
|
| Rate for Payer: OMNI Networks Commercial |
$543.20
|
| Rate for Payer: One Health Plan PPO/POS |
$698.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$737.20
|
| Rate for Payer: Three Rivers Provider Network All |
$582.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$721.68
|
| Rate for Payer: Zelis Auto |
$310.40
|
|
|
IMPLT SCREW LOCKING 4.0X22MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Humana ChoiceCare |
$259.22
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$598.20
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$877.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$249.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.50
|
|
|
IMPLT SCREW LOCKING 4.0X22MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$797.60
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$697.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
|
|
IMPLT SCREW LOCKING 4.0X24MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$797.60
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$697.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
|
|
IMPLT SCREW LOCKING 4.0X24MM
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$655.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$552.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$586.50
|
| Rate for Payer: First Health Commercial |
$621.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.00
|
| Rate for Payer: GEHA Commercial |
$483.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.00
|
| Rate for Payer: Multiplan All |
$627.90
|
| Rate for Payer: OMNI Networks Commercial |
$483.00
|
| Rate for Payer: One Health Plan PPO/POS |
$621.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$655.50
|
| Rate for Payer: Three Rivers Provider Network All |
$517.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$641.70
|
| Rate for Payer: Zelis Auto |
$276.00
|
|
|
IMPLT SCREW LOCKING 4.0X24MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Humana ChoiceCare |
$259.22
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$598.20
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$877.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$249.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.50
|
|
|
IMPLT SCREW LOCKING 4.0X24MM
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$655.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$586.50
|
| Rate for Payer: First Health Commercial |
$621.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$621.00
|
| Rate for Payer: GEHA Commercial |
$552.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$621.00
|
| Rate for Payer: Humana ChoiceCare |
$179.40
|
| Rate for Payer: Multiplan All |
$627.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$414.00
|
| Rate for Payer: OMNI Networks Commercial |
$483.00
|
| Rate for Payer: One Health Plan PPO/POS |
$621.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$655.50
|
| Rate for Payer: Three Rivers Provider Network All |
$517.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$607.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$172.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$641.70
|
| Rate for Payer: Zelis Auto |
$276.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$345.00
|
|
|
IMPLT SCREW LOCKING 4.0X26MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Humana ChoiceCare |
$259.22
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$598.20
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$877.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$249.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.50
|
|
|
IMPLT SCREW LOCKING 4.0X26MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$797.60
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$697.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
|
|
IMPLT SCREW LOCKING 4.0X28MM
|
Facility
|
IP
|
$913.52
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.41 |
| Max. Negotiated Rate |
$867.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$730.82
|
| Rate for Payer: Cash Price |
$548.11
|
| Rate for Payer: Cash Price |
$548.11
|
| Rate for Payer: Cigna Commercial |
$776.49
|
| Rate for Payer: First Health Commercial |
$822.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.17
|
| Rate for Payer: GEHA Commercial |
$639.46
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.17
|
| Rate for Payer: Multiplan All |
$831.30
|
| Rate for Payer: OMNI Networks Commercial |
$639.46
|
| Rate for Payer: One Health Plan PPO/POS |
$822.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$867.84
|
| Rate for Payer: Three Rivers Provider Network All |
$685.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$849.57
|
| Rate for Payer: Zelis Auto |
$365.41
|
|
|
IMPLT SCREW LOCKING 4.0X28MM
|
Facility
|
OP
|
$913.52
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.38 |
| Max. Negotiated Rate |
$867.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.11
|
| Rate for Payer: Cash Price |
$548.11
|
| Rate for Payer: Cash Price |
$548.11
|
| Rate for Payer: Cigna Commercial |
$776.49
|
| Rate for Payer: First Health Commercial |
$822.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.17
|
| Rate for Payer: GEHA Commercial |
$730.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.17
|
| Rate for Payer: Humana ChoiceCare |
$237.52
|
| Rate for Payer: Multiplan All |
$831.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$548.11
|
| Rate for Payer: OMNI Networks Commercial |
$639.46
|
| Rate for Payer: One Health Plan PPO/POS |
$822.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$867.84
|
| Rate for Payer: Three Rivers Provider Network All |
$685.14
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$803.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$849.57
|
| Rate for Payer: Zelis Auto |
$365.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$456.76
|
|
|
IMPLT SCREW LOCKING 4.0X30MM
|
Facility
|
OP
|
$913.52
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.38 |
| Max. Negotiated Rate |
$867.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.11
|
| Rate for Payer: Cash Price |
$548.11
|
| Rate for Payer: Cash Price |
$548.11
|
| Rate for Payer: Cigna Commercial |
$776.49
|
| Rate for Payer: First Health Commercial |
$822.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.17
|
| Rate for Payer: GEHA Commercial |
$730.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.17
|
| Rate for Payer: Humana ChoiceCare |
$237.52
|
| Rate for Payer: Multiplan All |
$831.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$548.11
|
| Rate for Payer: OMNI Networks Commercial |
$639.46
|
| Rate for Payer: One Health Plan PPO/POS |
$822.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$867.84
|
| Rate for Payer: Three Rivers Provider Network All |
$685.14
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$803.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$849.57
|
| Rate for Payer: Zelis Auto |
$365.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$456.76
|
|
|
IMPLT SCREW LOCKING 4.0X30MM
|
Facility
|
IP
|
$913.52
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.41 |
| Max. Negotiated Rate |
$867.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$730.82
|
| Rate for Payer: Cash Price |
$548.11
|
| Rate for Payer: Cash Price |
$548.11
|
| Rate for Payer: Cigna Commercial |
$776.49
|
| Rate for Payer: First Health Commercial |
$822.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.17
|
| Rate for Payer: GEHA Commercial |
$639.46
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.17
|
| Rate for Payer: Multiplan All |
$831.30
|
| Rate for Payer: OMNI Networks Commercial |
$639.46
|
| Rate for Payer: One Health Plan PPO/POS |
$822.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$867.84
|
| Rate for Payer: Three Rivers Provider Network All |
$685.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$849.57
|
| Rate for Payer: Zelis Auto |
$365.41
|
|
|
IMPLT SCREW LOCKING 4.0X32MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Humana ChoiceCare |
$259.22
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$598.20
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$877.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$249.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.50
|
|
