|
IMPLT SCREW LOCKING TAP SELF 4.0X14MM
|
Facility
|
OP
|
$1,113.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.25 |
| Max. Negotiated Rate |
$1,057.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$667.80
|
| 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 |
$890.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,001.70
|
| Rate for Payer: Humana ChoiceCare |
$289.38
|
| Rate for Payer: Multiplan All |
$1,012.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$667.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$979.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$278.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,035.09
|
| Rate for Payer: Zelis Auto |
$445.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$556.50
|
|
|
IMPLT SCREW LOCKING TAP SELF 4.0X16MM
|
Facility
|
IP
|
$913.52
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.41 |
| Max. Negotiated Rate |
$867.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$730.82
|
| Rate for Payer: Cash Price |
$548.11
|
| Rate for Payer: Cash Price |
$548.11
|
| Rate for Payer: Cigna Commercial |
$776.49
|
| Rate for Payer: First Health Commercial |
$822.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.17
|
| Rate for Payer: GEHA Commercial |
$639.46
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.17
|
| Rate for Payer: Multiplan All |
$831.30
|
| Rate for Payer: OMNI Networks Commercial |
$639.46
|
| Rate for Payer: One Health Plan PPO/POS |
$822.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$867.84
|
| Rate for Payer: Three Rivers Provider Network All |
$685.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$849.57
|
| Rate for Payer: Zelis Auto |
$365.41
|
|
|
IMPLT SCREW LOCKING TAP SELF 4.0X16MM
|
Facility
|
OP
|
$913.52
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.38 |
| Max. Negotiated Rate |
$867.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.11
|
| Rate for Payer: Cash Price |
$548.11
|
| Rate for Payer: Cash Price |
$548.11
|
| Rate for Payer: Cigna Commercial |
$776.49
|
| Rate for Payer: First Health Commercial |
$822.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.17
|
| Rate for Payer: GEHA Commercial |
$730.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.17
|
| Rate for Payer: Humana ChoiceCare |
$237.52
|
| Rate for Payer: Multiplan All |
$831.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$548.11
|
| Rate for Payer: OMNI Networks Commercial |
$639.46
|
| Rate for Payer: One Health Plan PPO/POS |
$822.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$867.84
|
| Rate for Payer: Three Rivers Provider Network All |
$685.14
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$803.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$849.57
|
| Rate for Payer: Zelis Auto |
$365.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$456.76
|
|
|
IMPLT SCREW LOCKING TAP SELF 4.0X18MM
|
Facility
|
IP
|
$1,113.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002658
|
|
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
|
|
|
IMPLT SCREW LOCKING TAP SELF 4.0X18MM
|
Facility
|
OP
|
$1,113.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.25 |
| Max. Negotiated Rate |
$1,057.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$667.80
|
| 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 |
$890.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,001.70
|
| Rate for Payer: Humana ChoiceCare |
$289.38
|
| Rate for Payer: Multiplan All |
$1,012.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$667.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$979.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$278.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,035.09
|
| Rate for Payer: Zelis Auto |
$445.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$556.50
|
|
|
IMPLT SCREW LOCKING THREADED 05X42MM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW LOCKING THREADED 05X42MM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW LOCKING THREADED 05X55MM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW LOCKING THREADED 05X55MM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW LOCKING THREADED 05X60MM
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.25 |
| Max. Negotiated Rate |
$931.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cigna Commercial |
$833.85
|
| Rate for Payer: First Health Commercial |
$882.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$882.90
|
| Rate for Payer: GEHA Commercial |
$784.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$882.90
|
| Rate for Payer: Humana ChoiceCare |
$255.06
|
| Rate for Payer: Multiplan All |
$892.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$588.60
|
| Rate for Payer: OMNI Networks Commercial |
$686.70
|
| Rate for Payer: One Health Plan PPO/POS |
$882.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$931.95
|
| Rate for Payer: Three Rivers Provider Network All |
$735.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$863.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$245.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$912.33
|
| Rate for Payer: Zelis Auto |
$392.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$490.50
|
|
|
IMPLT SCREW LOCKING THREADED 05X60MM
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.40 |
| Max. Negotiated Rate |
$931.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$784.80
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cigna Commercial |
$833.85
|
| Rate for Payer: First Health Commercial |
$882.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$882.90
|
| Rate for Payer: GEHA Commercial |
$686.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$882.90
|
| Rate for Payer: Multiplan All |
$892.71
|
| Rate for Payer: OMNI Networks Commercial |
$686.70
|
| Rate for Payer: One Health Plan PPO/POS |
$882.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$931.95
|
| Rate for Payer: Three Rivers Provider Network All |
$735.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$912.33
|
| Rate for Payer: Zelis Auto |
$392.40
|
|
|
IMPLT SCREW LOCKING THREADED 2.7X26MM
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.80
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$609.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
|
|
IMPLT SCREW LOCKING THREADED 2.7X26MM
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$696.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Humana ChoiceCare |
$226.46
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$522.60
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$766.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$217.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$435.50
|
|
|
IMPLT SCREW LOCKING THREADED 4X40MM
|
Facility
|
IP
|
$1,027.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.80 |
| Max. Negotiated Rate |
$975.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$821.60
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cigna Commercial |
$872.95
|
| Rate for Payer: First Health Commercial |
$924.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$924.30
|
| Rate for Payer: GEHA Commercial |
$718.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$924.30
|
| Rate for Payer: Multiplan All |
$934.57
|
| Rate for Payer: OMNI Networks Commercial |
$718.90
|
| Rate for Payer: One Health Plan PPO/POS |
$924.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$975.65
|
| Rate for Payer: Three Rivers Provider Network All |
$770.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$955.11
|
| Rate for Payer: Zelis Auto |
$410.80
|
|
|
IMPLT SCREW LOCKING THREADED 4X40MM
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.75 |
| Max. Negotiated Rate |
$975.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$616.20
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cigna Commercial |
$872.95
|
| Rate for Payer: First Health Commercial |
$924.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$924.30
|
| Rate for Payer: GEHA Commercial |
$821.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$924.30
|
| Rate for Payer: Humana ChoiceCare |
$267.02
|
| Rate for Payer: Multiplan All |
$934.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$616.20
|
| Rate for Payer: OMNI Networks Commercial |
$718.90
|
| Rate for Payer: One Health Plan PPO/POS |
$924.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$975.65
|
| Rate for Payer: Three Rivers Provider Network All |
$770.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$903.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$256.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$955.11
|
| Rate for Payer: Zelis Auto |
$410.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$513.50
|
|
|
IMPLT SCREW LOCKING THREADED FULLY 5X30M
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW LOCKING THREADED FULLY 5X30M
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW LOCKING THREADED FULLY 5X32M
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW LOCKING THREADED FULLY 5X32M
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW LOCKING THREAD FULL 2.4X10MM
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.80
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$609.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
|
|
IMPLT SCREW LOCKING THREAD FULL 2.4X10MM
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$696.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Humana ChoiceCare |
$226.46
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$522.60
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$766.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$217.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$435.50
|
|
|
IMPLT SCREW LOCKING THREAD FULL 2.4X12MM
|
Facility
|
IP
|
$769.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.68 |
| Max. Negotiated Rate |
$730.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$615.36
|
| Rate for Payer: Cash Price |
$461.52
|
| Rate for Payer: Cash Price |
$461.52
|
| Rate for Payer: Cigna Commercial |
$653.82
|
| Rate for Payer: First Health Commercial |
$692.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$692.28
|
| Rate for Payer: GEHA Commercial |
$538.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$692.28
|
| Rate for Payer: Multiplan All |
$699.97
|
| Rate for Payer: OMNI Networks Commercial |
$538.44
|
| Rate for Payer: One Health Plan PPO/POS |
$692.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$730.74
|
| Rate for Payer: Three Rivers Provider Network All |
$576.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$715.36
|
| Rate for Payer: Zelis Auto |
$307.68
|
|
|
IMPLT SCREW LOCKING THREAD FULL 2.4X12MM
|
Facility
|
OP
|
$769.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.30 |
| Max. Negotiated Rate |
$730.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$461.52
|
| Rate for Payer: Cash Price |
$461.52
|
| Rate for Payer: Cash Price |
$461.52
|
| Rate for Payer: Cigna Commercial |
$653.82
|
| Rate for Payer: First Health Commercial |
$692.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$692.28
|
| Rate for Payer: GEHA Commercial |
$615.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$692.28
|
| Rate for Payer: Humana ChoiceCare |
$199.99
|
| Rate for Payer: Multiplan All |
$699.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$461.52
|
| Rate for Payer: OMNI Networks Commercial |
$538.44
|
| Rate for Payer: One Health Plan PPO/POS |
$692.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$730.74
|
| Rate for Payer: Three Rivers Provider Network All |
$576.90
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$676.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$192.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$715.36
|
| Rate for Payer: Zelis Auto |
$307.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$384.60
|
|
|
IMPLT SCREW LOCKING THREAD FULL 2.4X14MM
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.80
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$609.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
|
|
IMPLT SCREW LOCKING THREAD FULL 2.4X14MM
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$696.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Humana ChoiceCare |
$226.46
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$522.60
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$766.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$217.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$435.50
|
|
