|
IMPLT SCREW LOCKING 4.0X32MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000586
|
|
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 4.0X34MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002692
|
|
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 4.0X34MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002692
|
|
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 4.0X36MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002691
|
|
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 4.0X36MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002691
|
|
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 4.0X38MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003263
|
|
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 4.0X38MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003263
|
|
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 4.0X40MM
|
Facility
|
OP
|
$913.52
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002606
|
|
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 4.0X40MM
|
Facility
|
IP
|
$913.52
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002606
|
|
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 4.0X42MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003264
|
|
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 4.0X42MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003264
|
|
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 4.0X44MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002693
|
|
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 4.0X44MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002693
|
|
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 4.0X46MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003341
|
|
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 4.0X46MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003341
|
|
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 4.0X48MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003262
|
|
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 4.0X48MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003262
|
|
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 4.0X50MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002833
|
|
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 4.0X50MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002833
|
|
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 4.0X55MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003218
|
|
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 4.0X55MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003218
|
|
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 4.0X60MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002860
|
|
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 4.0X60MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002860
|
|
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 4.0X65MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002894
|
|
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 4.0X65MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002894
|
|
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
|
|
