|
IMPLT SCREW LOCKING SELF TAP 3.5X18
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001522
|
|
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 3.5X20
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000958
|
|
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 3.5X20
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000958
|
|
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 3.5X22
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000959
|
|
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 3.5X22
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000959
|
|
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 3.5X24
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001529
|
|
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 3.5X24
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001529
|
|
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 3.5X26
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001523
|
|
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 3.5X26
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001523
|
|
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 3.5X28
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001524
|
|
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 3.5X28
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001524
|
|
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 3.5X30
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001525
|
|
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 3.5X30
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001525
|
|
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 3.5X32
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001530
|
|
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 3.5X32
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001530
|
|
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 3.5X34
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001526
|
|
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 3.5X34
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001526
|
|
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 3.5X36
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001531
|
|
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 3.5X36
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001531
|
|
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 3.5X38
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001532
|
|
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 3.5X38
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001532
|
|
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 3.5X40
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001533
|
|
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 3.5X40
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001533
|
|
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 3.5X45MM
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001534
|
|
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 3.5X45MM
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001534
|
|
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
|
|
