|
IMPLT SCREW THREAD 5.0MMX38MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THREAD 5.0MMX38MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THREAD 5.0MMX38MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THREAD 5.0MMX38MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THREAD 5.0MMX40MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THREAD 5.0MMX40MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THREAD 5.0MMX42MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THREAD 5.0MMX42MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THREAD 5.0MMX42MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THREAD 5.0MMX42MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THREAD 5.0MMX44MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THREAD 5.0MMX44MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THREAD 5.0MMX44MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THREAD 5.0MMX44MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THREAD 5.0MMX46MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THREAD 5.0MMX46MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THREAD 5.0MMX48MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THREAD 5.0MMX48MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THREAD 5.0MMX48MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THREAD 5.0MMX48MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THREAD 5.0MMX50MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THREAD 5.0MMX50MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THREAD 5.0MMX50MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
|
IMPLT SCREW THREAD 5.0MMX50MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.80
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
|
|
IMPLT SCREW THREAD 5.0MMX55MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$112.06
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.60
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$379.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.50
|
|
