|
IMPLT SCREW LOCKING THREAD FULL 2.4X16MM
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006234
|
|
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 2.4X16MM
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006234
|
|
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 2.4X18MM
|
Facility
|
IP
|
$769.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006235
|
|
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 2.4X18MM
|
Facility
|
OP
|
$769.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006235
|
|
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 2.4X20MM
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006236
|
|
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 2.4X20MM
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006236
|
|
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 2.4X22MM
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002848
|
|
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 2.4X22MM
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002848
|
|
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 2.4X8MM
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$635.20
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$555.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
|
|
IMPLT SCREW LOCKING THREAD FULL 2.4X8MM
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$674.90
|
| Rate for Payer: First Health Commercial |
$714.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$714.60
|
| Rate for Payer: GEHA Commercial |
$635.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$714.60
|
| Rate for Payer: Humana ChoiceCare |
$206.44
|
| Rate for Payer: Multiplan All |
$722.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.40
|
| Rate for Payer: OMNI Networks Commercial |
$555.80
|
| Rate for Payer: One Health Plan PPO/POS |
$714.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$754.30
|
| Rate for Payer: Three Rivers Provider Network All |
$595.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$698.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$198.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$738.42
|
| Rate for Payer: Zelis Auto |
$317.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$397.00
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 34MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$797.60
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$697.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 34MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Humana ChoiceCare |
$259.22
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$598.20
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$877.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$249.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.50
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 36MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Humana ChoiceCare |
$259.22
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$598.20
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$877.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$249.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.50
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 36MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$797.60
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$697.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 38MM
|
Facility
|
IP
|
$389.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$369.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$311.36
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cigna Commercial |
$330.82
|
| Rate for Payer: First Health Commercial |
$350.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$350.28
|
| Rate for Payer: GEHA Commercial |
$272.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$350.28
|
| Rate for Payer: Multiplan All |
$354.17
|
| Rate for Payer: OMNI Networks Commercial |
$272.44
|
| Rate for Payer: One Health Plan PPO/POS |
$350.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.74
|
| Rate for Payer: Three Rivers Provider Network All |
$291.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.96
|
| Rate for Payer: Zelis Auto |
$155.68
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 38MM
|
Facility
|
OP
|
$389.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$369.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cigna Commercial |
$330.82
|
| Rate for Payer: First Health Commercial |
$350.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$350.28
|
| Rate for Payer: GEHA Commercial |
$311.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$350.28
|
| Rate for Payer: Humana ChoiceCare |
$101.19
|
| Rate for Payer: Multiplan All |
$354.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$233.52
|
| Rate for Payer: OMNI Networks Commercial |
$272.44
|
| Rate for Payer: One Health Plan PPO/POS |
$350.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.74
|
| Rate for Payer: Three Rivers Provider Network All |
$291.90
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$342.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.96
|
| Rate for Payer: Zelis Auto |
$155.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$194.60
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 40MM
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 40MM
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$79.30
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.00
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$268.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.50
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 42MM
|
Facility
|
IP
|
$389.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$369.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$311.36
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cigna Commercial |
$330.82
|
| Rate for Payer: First Health Commercial |
$350.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$350.28
|
| Rate for Payer: GEHA Commercial |
$272.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$350.28
|
| Rate for Payer: Multiplan All |
$354.17
|
| Rate for Payer: OMNI Networks Commercial |
$272.44
|
| Rate for Payer: One Health Plan PPO/POS |
$350.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.74
|
| Rate for Payer: Three Rivers Provider Network All |
$291.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.96
|
| Rate for Payer: Zelis Auto |
$155.68
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 42MM
|
Facility
|
OP
|
$389.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$369.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cash Price |
$233.52
|
| Rate for Payer: Cigna Commercial |
$330.82
|
| Rate for Payer: First Health Commercial |
$350.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$350.28
|
| Rate for Payer: GEHA Commercial |
$311.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$350.28
|
| Rate for Payer: Humana ChoiceCare |
$101.19
|
| Rate for Payer: Multiplan All |
$354.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$233.52
|
| Rate for Payer: OMNI Networks Commercial |
$272.44
|
| Rate for Payer: One Health Plan PPO/POS |
$350.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.74
|
| Rate for Payer: Three Rivers Provider Network All |
$291.90
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$342.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.96
|
| Rate for Payer: Zelis Auto |
$155.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$194.60
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 50MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$797.60
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$697.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 50MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Humana ChoiceCare |
$259.22
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$598.20
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$877.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$249.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.50
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 70MM
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$797.60
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$697.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
|
|
IMPLT SCREW LOCK-NON 3.5 X 70MM
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Humana ChoiceCare |
$259.22
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$598.20
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$877.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$249.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$498.50
|
|
|
IMPLT SCREW LOCK PRO-LO 2.7X12MM
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$739.20
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$785.40
|
| Rate for Payer: First Health Commercial |
$831.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$831.60
|
| Rate for Payer: GEHA Commercial |
$646.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$831.60
|
| Rate for Payer: Multiplan All |
$840.84
|
| Rate for Payer: OMNI Networks Commercial |
$646.80
|
| Rate for Payer: One Health Plan PPO/POS |
$831.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$877.80
|
| Rate for Payer: Three Rivers Provider Network All |
$693.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$859.32
|
| Rate for Payer: Zelis Auto |
$369.60
|
|
