|
IMPLT SCREW LOCKING 5.0X55MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006209
|
|
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 LOCKING 5.0X55MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006209
|
|
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 LOCKING 5.0X60MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008003
|
|
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 LOCKING 5.0X60MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008003
|
|
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 LOCKING 5.0X65MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002624
|
|
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 LOCKING 5.0X65MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002624
|
|
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 LOCKING 5.0X70MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002618
|
|
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 LOCKING 5.0X70MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002618
|
|
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 LOCKING 5.0X75MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002870
|
|
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 LOCKING 5.0X75MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002870
|
|
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 LOCKING 5.0X80MM
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003067
|
|
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 LOCKING 5.0X80MM
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003067
|
|
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 LOCKING 5X10MM PERI
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.25 |
| Max. Negotiated Rate |
$1,102.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$928.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| Rate for Payer: Humana ChoiceCare |
$301.86
|
| Rate for Payer: Multiplan All |
$1,056.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$696.60
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.95
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,021.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$290.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,079.73
|
| Rate for Payer: Zelis Auto |
$464.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.50
|
|
|
IMPLT SCREW LOCKING 5X10MM PERI
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.40 |
| Max. Negotiated Rate |
$1,102.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$928.80
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$812.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| Rate for Payer: Multiplan All |
$1,056.51
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.95
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,079.73
|
| Rate for Payer: Zelis Auto |
$464.40
|
|
|
IMPLT SCREW LOCKING 5X14MM PERI
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.25 |
| Max. Negotiated Rate |
$1,102.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$928.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| Rate for Payer: Humana ChoiceCare |
$301.86
|
| Rate for Payer: Multiplan All |
$1,056.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$696.60
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.95
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,021.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$290.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,079.73
|
| Rate for Payer: Zelis Auto |
$464.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.50
|
|
|
IMPLT SCREW LOCKING 5X14MM PERI
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.40 |
| Max. Negotiated Rate |
$1,102.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$928.80
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$812.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| Rate for Payer: Multiplan All |
$1,056.51
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.95
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,079.73
|
| Rate for Payer: Zelis Auto |
$464.40
|
|
|
IMPLT SCREW LOCKING 5X18MM
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.40 |
| Max. Negotiated Rate |
$1,102.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$928.80
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$812.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| Rate for Payer: Multiplan All |
$1,056.51
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.95
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,079.73
|
| Rate for Payer: Zelis Auto |
$464.40
|
|
|
IMPLT SCREW LOCKING 5X18MM
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.25 |
| Max. Negotiated Rate |
$1,102.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$928.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| Rate for Payer: Humana ChoiceCare |
$301.86
|
| Rate for Payer: Multiplan All |
$1,056.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$696.60
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.95
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,021.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$290.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,079.73
|
| Rate for Payer: Zelis Auto |
$464.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.50
|
|
|
IMPLT SCREW LOCKING 5X18MM PERI
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.25 |
| Max. Negotiated Rate |
$1,102.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$928.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| Rate for Payer: Humana ChoiceCare |
$301.86
|
| Rate for Payer: Multiplan All |
$1,056.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$696.60
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.95
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,021.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$290.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,079.73
|
| Rate for Payer: Zelis Auto |
$464.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.50
|
|
|
IMPLT SCREW LOCKING 5X18MM PERI
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.40 |
| Max. Negotiated Rate |
$1,102.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$928.80
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$812.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| Rate for Payer: Multiplan All |
$1,056.51
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.95
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,079.73
|
| Rate for Payer: Zelis Auto |
$464.40
|
|
|
IMPLT SCREW LOCKING 5X22MM
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.25 |
| Max. Negotiated Rate |
$1,102.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$928.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| Rate for Payer: Humana ChoiceCare |
$301.86
|
| Rate for Payer: Multiplan All |
$1,056.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$696.60
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.95
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,021.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$290.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,079.73
|
| Rate for Payer: Zelis Auto |
$464.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.50
|
|
|
IMPLT SCREW LOCKING 5X22MM
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.40 |
| Max. Negotiated Rate |
$1,102.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$928.80
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$812.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| Rate for Payer: Multiplan All |
$1,056.51
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.95
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,079.73
|
| Rate for Payer: Zelis Auto |
$464.40
|
|
|
IMPLT SCREW LOCKING 5X24MM
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.25 |
| Max. Negotiated Rate |
$1,102.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$928.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| Rate for Payer: Humana ChoiceCare |
$301.86
|
| Rate for Payer: Multiplan All |
$1,056.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$696.60
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.95
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,021.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$290.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,079.73
|
| Rate for Payer: Zelis Auto |
$464.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.50
|
|
|
IMPLT SCREW LOCKING 5X24MM
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.40 |
| Max. Negotiated Rate |
$1,102.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$928.80
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$812.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| Rate for Payer: Multiplan All |
$1,056.51
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.95
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,079.73
|
| Rate for Payer: Zelis Auto |
$464.40
|
|
|
IMPLT SCREW LOCKING 5X8MM PERI
|
Facility
|
OP
|
$1,351.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.75 |
| Max. Negotiated Rate |
$1,283.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$1,148.35
|
| Rate for Payer: First Health Commercial |
$1,215.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,215.90
|
| Rate for Payer: GEHA Commercial |
$1,080.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,215.90
|
| Rate for Payer: Humana ChoiceCare |
$351.26
|
| Rate for Payer: Multiplan All |
$1,229.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$810.60
|
| Rate for Payer: OMNI Networks Commercial |
$945.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,215.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,283.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,013.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,188.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$337.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,256.43
|
| Rate for Payer: Zelis Auto |
$540.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$675.50
|
|
