|
IMPLT SCREW LOCKING SELF TAP 3.5X50MM
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001535
|
|
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 3.5X50MM
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001535
|
|
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 3.5X55MM
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001536
|
|
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 3.5X55MM
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001536
|
|
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 3.5X60MM
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.50 |
| Max. Negotiated Rate |
$1,787.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,129.20
|
| Rate for Payer: Cash Price |
$1,129.20
|
| Rate for Payer: Cash Price |
$1,129.20
|
| Rate for Payer: Cigna Commercial |
$1,599.70
|
| Rate for Payer: First Health Commercial |
$1,693.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,693.80
|
| Rate for Payer: GEHA Commercial |
$1,505.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,693.80
|
| Rate for Payer: Humana ChoiceCare |
$489.32
|
| Rate for Payer: Multiplan All |
$1,712.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,129.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,317.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,693.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,787.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,411.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,656.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$470.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,750.26
|
| Rate for Payer: Zelis Auto |
$752.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$941.00
|
|
|
IMPLT SCREW LOCKING SELF TAP 3.5X60MM
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$752.80 |
| Max. Negotiated Rate |
$1,787.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,505.60
|
| Rate for Payer: Cash Price |
$1,129.20
|
| Rate for Payer: Cash Price |
$1,129.20
|
| Rate for Payer: Cigna Commercial |
$1,599.70
|
| Rate for Payer: First Health Commercial |
$1,693.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,693.80
|
| Rate for Payer: GEHA Commercial |
$1,317.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,693.80
|
| Rate for Payer: Multiplan All |
$1,712.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,317.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,693.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,787.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,411.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,750.26
|
| Rate for Payer: Zelis Auto |
$752.80
|
|
|
IMPLT SCREW LOCKING T10 3.5X28MM
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.75 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$716.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Humana ChoiceCare |
$232.70
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$537.00
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$787.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$447.50
|
|
|
IMPLT SCREW LOCKING T10 3.5X28MM
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.00 |
| Max. Negotiated Rate |
$850.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$716.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$760.75
|
| Rate for Payer: First Health Commercial |
$805.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$805.50
|
| Rate for Payer: GEHA Commercial |
$626.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$805.50
|
| Rate for Payer: Multiplan All |
$814.45
|
| Rate for Payer: OMNI Networks Commercial |
$626.50
|
| Rate for Payer: One Health Plan PPO/POS |
$805.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$850.25
|
| Rate for Payer: Three Rivers Provider Network All |
$671.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$832.35
|
| Rate for Payer: Zelis Auto |
$358.00
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X10MM
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.60 |
| Max. Negotiated Rate |
$792.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$667.20
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: First Health Commercial |
$750.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$750.60
|
| Rate for Payer: GEHA Commercial |
$583.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| Rate for Payer: Multiplan All |
$758.94
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$792.30
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$775.62
|
| Rate for Payer: Zelis Auto |
$333.60
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X10MM
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$208.50 |
| Max. Negotiated Rate |
$792.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$500.40
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: First Health Commercial |
$750.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$750.60
|
| Rate for Payer: GEHA Commercial |
$667.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| Rate for Payer: Humana ChoiceCare |
$216.84
|
| Rate for Payer: Multiplan All |
$758.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$500.40
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$792.30
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$733.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$775.62
|
| Rate for Payer: Zelis Auto |
$333.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$417.00
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X10MM
|
Facility
|
OP
|
$1,391.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.75 |
| Max. Negotiated Rate |
$1,321.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$834.60
|
| Rate for Payer: Cash Price |
$834.60
|
| Rate for Payer: Cash Price |
$834.60
|
| Rate for Payer: Cigna Commercial |
$1,182.35
|
| Rate for Payer: First Health Commercial |
$1,251.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,251.90
|
| Rate for Payer: GEHA Commercial |
$1,112.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,251.90
|
| Rate for Payer: Humana ChoiceCare |
$361.66
|
| Rate for Payer: Multiplan All |
$1,265.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$834.60
|
| Rate for Payer: OMNI Networks Commercial |
$973.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,251.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,321.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,043.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,224.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$347.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,293.63
|
| Rate for Payer: Zelis Auto |
$556.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$695.50
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X10MM
|
Facility
|
IP
|
$1,391.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.40 |
| Max. Negotiated Rate |
$1,321.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,112.80
|
| Rate for Payer: Cash Price |
$834.60
|
| Rate for Payer: Cash Price |
$834.60
|
| Rate for Payer: Cigna Commercial |
$1,182.35
|
| Rate for Payer: First Health Commercial |
$1,251.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,251.90
|
| Rate for Payer: GEHA Commercial |
$973.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,251.90
|
| Rate for Payer: Multiplan All |
$1,265.81
|
| Rate for Payer: OMNI Networks Commercial |
$973.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,251.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,321.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,043.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,293.63
|
| Rate for Payer: Zelis Auto |
$556.40
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X12MM
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.60 |
| Max. Negotiated Rate |
$792.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$667.20
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: First Health Commercial |
$750.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$750.60
|
| Rate for Payer: GEHA Commercial |
$583.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| Rate for Payer: Multiplan All |
$758.94
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$792.30
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$775.62
|
| Rate for Payer: Zelis Auto |
$333.60
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X12MM
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$208.50 |
| Max. Negotiated Rate |
$792.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$500.40
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: First Health Commercial |
$750.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$750.60
|
| Rate for Payer: GEHA Commercial |
$667.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| Rate for Payer: Humana ChoiceCare |
$216.84
|
| Rate for Payer: Multiplan All |
$758.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$500.40
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$792.30
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$733.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$775.62
|
| Rate for Payer: Zelis Auto |
$333.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$417.00
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X12MM
|
Facility
|
OP
|
$1,391.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.75 |
| Max. Negotiated Rate |
$1,321.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$834.60
|
| Rate for Payer: Cash Price |
$834.60
|
| Rate for Payer: Cash Price |
$834.60
|
| Rate for Payer: Cigna Commercial |
$1,182.35
|
| Rate for Payer: First Health Commercial |
$1,251.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,251.90
|
| Rate for Payer: GEHA Commercial |
$1,112.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,251.90
|
| Rate for Payer: Humana ChoiceCare |
$361.66
|
| Rate for Payer: Multiplan All |
$1,265.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$834.60
|
| Rate for Payer: OMNI Networks Commercial |
$973.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,251.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,321.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,043.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,224.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$347.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,293.63
|
| Rate for Payer: Zelis Auto |
$556.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$695.50
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X12MM
|
Facility
|
IP
|
$1,391.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.40 |
| Max. Negotiated Rate |
$1,321.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,112.80
|
| Rate for Payer: Cash Price |
$834.60
|
| Rate for Payer: Cash Price |
$834.60
|
| Rate for Payer: Cigna Commercial |
$1,182.35
|
| Rate for Payer: First Health Commercial |
$1,251.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,251.90
|
| Rate for Payer: GEHA Commercial |
$973.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,251.90
|
| Rate for Payer: Multiplan All |
$1,265.81
|
| Rate for Payer: OMNI Networks Commercial |
$973.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,251.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,321.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,043.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,293.63
|
| Rate for Payer: Zelis Auto |
$556.40
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X16MM
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.40 |
| Max. Negotiated Rate |
$851.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$716.80
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$761.60
|
| Rate for Payer: First Health Commercial |
$806.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$806.40
|
| Rate for Payer: GEHA Commercial |
$627.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$806.40
|
| Rate for Payer: Multiplan All |
$815.36
|
| Rate for Payer: OMNI Networks Commercial |
$627.20
|
| Rate for Payer: One Health Plan PPO/POS |
$806.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$851.20
|
| Rate for Payer: Three Rivers Provider Network All |
$672.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$833.28
|
| Rate for Payer: Zelis Auto |
$358.40
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X16MM
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$851.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$761.60
|
| Rate for Payer: First Health Commercial |
$806.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$806.40
|
| Rate for Payer: GEHA Commercial |
$716.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$806.40
|
| Rate for Payer: Humana ChoiceCare |
$232.96
|
| Rate for Payer: Multiplan All |
$815.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$537.60
|
| Rate for Payer: OMNI Networks Commercial |
$627.20
|
| Rate for Payer: One Health Plan PPO/POS |
$806.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$851.20
|
| Rate for Payer: Three Rivers Provider Network All |
$672.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$788.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$833.28
|
| Rate for Payer: Zelis Auto |
$358.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$448.00
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X38MM
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$704.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Humana ChoiceCare |
$229.06
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$528.60
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$775.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$440.50
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X38MM
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$704.80
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$748.85
|
| Rate for Payer: First Health Commercial |
$792.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$792.90
|
| Rate for Payer: GEHA Commercial |
$616.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$792.90
|
| Rate for Payer: Multiplan All |
$801.71
|
| Rate for Payer: OMNI Networks Commercial |
$616.70
|
| Rate for Payer: One Health Plan PPO/POS |
$792.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$836.95
|
| Rate for Payer: Three Rivers Provider Network All |
$660.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$819.33
|
| Rate for Payer: Zelis Auto |
$352.40
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X48MM
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$775.20
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$678.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X48MM
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$775.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Humana ChoiceCare |
$251.94
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$581.40
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$852.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$484.50
|
|
|
IMPLT SCREW LOCKING TAP SELF 3.5X52MM
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002630
|
|
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 TAP SELF 3.5X52MM
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002630
|
|
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 TAP SELF 4.0X14MM
|
Facility
|
IP
|
$1,113.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.20 |
| Max. Negotiated Rate |
$1,057.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$890.40
|
| Rate for Payer: Cash Price |
$667.80
|
| Rate for Payer: Cash Price |
$667.80
|
| Rate for Payer: Cigna Commercial |
$946.05
|
| Rate for Payer: First Health Commercial |
$1,001.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,001.70
|
| Rate for Payer: GEHA Commercial |
$779.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,001.70
|
| Rate for Payer: Multiplan All |
$1,012.83
|
| Rate for Payer: OMNI Networks Commercial |
$779.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,001.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,057.35
|
| Rate for Payer: Three Rivers Provider Network All |
$834.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,035.09
|
| Rate for Payer: Zelis Auto |
$445.20
|
|
