|
IMPLT SCREW LOCKING NON 3.5X44MM
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$484.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$423.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
|
|
IMPLT SCREW LOCKING NON 3.5X44MM
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.25 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$484.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Humana ChoiceCare |
$157.30
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$363.00
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$532.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$151.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.50
|
|
|
IMPLT SCREW LOCKING NON 4.5X28MM
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$243.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$273.60
|
| Rate for Payer: GEHA Commercial |
$212.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$273.60
|
| Rate for Payer: Multiplan All |
$276.64
|
| Rate for Payer: OMNI Networks Commercial |
$212.80
|
| Rate for Payer: One Health Plan PPO/POS |
$273.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$288.80
|
| Rate for Payer: Three Rivers Provider Network All |
$228.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$282.72
|
| Rate for Payer: Zelis Auto |
$121.60
|
|
|
IMPLT SCREW LOCKING NON 4.5X28MM
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$273.60
|
| Rate for Payer: GEHA Commercial |
$243.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$273.60
|
| Rate for Payer: Humana ChoiceCare |
$79.04
|
| Rate for Payer: Multiplan All |
$276.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$182.40
|
| Rate for Payer: OMNI Networks Commercial |
$212.80
|
| Rate for Payer: One Health Plan PPO/POS |
$273.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$288.80
|
| Rate for Payer: Three Rivers Provider Network All |
$228.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$267.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$282.72
|
| Rate for Payer: Zelis Auto |
$121.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.00
|
|
|
IMPLT SCREW LOCKING NON 4.5X40MM
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$87.36
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.60
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.00
|
|
|
IMPLT SCREW LOCKING NON 4.5X40MM
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
|
|
IMPLT SCREW LOCKING NON 4.5X42MM
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
|
|
IMPLT SCREW LOCKING NON 4.5X42MM
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$87.36
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.60
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.00
|
|
|
IMPLT SCREW LOCKING NON 4.5X46MM
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$87.36
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.60
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.00
|
|
|
IMPLT SCREW LOCKING NON 4.5X46MM
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
|
|
IMPLT SCREW LOCKING NON 4.5X48MM
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$87.36
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.60
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.00
|
|
|
IMPLT SCREW LOCKING NON 4.5X48MM
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
|
|
IMPLT SCREW LOCKING NON 4.5X50MM
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$87.36
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.60
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.00
|
|
|
IMPLT SCREW LOCKING NON 4.5X50MM
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
|
|
IMPLT SCREW LOCKING NON 4.5X65MM
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$268.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Humana ChoiceCare |
$87.36
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.60
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.00
|
|
|
IMPLT SCREW LOCKING NON 4.5X65MM
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$268.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$285.60
|
| Rate for Payer: First Health Commercial |
$302.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$302.40
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$302.40
|
| Rate for Payer: Multiplan All |
$305.76
|
| Rate for Payer: OMNI Networks Commercial |
$235.20
|
| Rate for Payer: One Health Plan PPO/POS |
$302.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$319.20
|
| Rate for Payer: Three Rivers Provider Network All |
$252.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$312.48
|
| Rate for Payer: Zelis Auto |
$134.40
|
|
|
IMPLT SCREW LOCKING SELF TAP 3.5X10
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.80 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$725.60
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$634.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
|
|
IMPLT SCREW LOCKING SELF TAP 3.5X10
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.75 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$725.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Humana ChoiceCare |
$235.82
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.20
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$798.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.50
|
|
|
IMPLT SCREW LOCKING SELF TAP 3.5X12
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.75 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$725.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Humana ChoiceCare |
$235.82
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.20
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$798.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.50
|
|
|
IMPLT SCREW LOCKING SELF TAP 3.5X12
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.80 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$725.60
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$634.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
|
|
IMPLT SCREW LOCKING SELF TAP 3.5X14
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.75 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$725.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Humana ChoiceCare |
$235.82
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.20
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$798.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.50
|
|
|
IMPLT SCREW LOCKING SELF TAP 3.5X14
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.80 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$725.60
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$634.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
|
|
IMPLT SCREW LOCKING SELF TAP 3.5X16
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.80 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$725.60
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$634.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
|
|
IMPLT SCREW LOCKING SELF TAP 3.5X16
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.75 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$725.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Humana ChoiceCare |
$235.82
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.20
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$798.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.50
|
|
|
IMPLT SCREW LOCKING SELF TAP 3.5X18
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.75 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$725.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Humana ChoiceCare |
$235.82
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.20
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$798.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.50
|
|
