|
IMPLT SCREW THREAD 5.0MMX55MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001062
|
|
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 5.0MMX55MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001062
|
|
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
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001063
|
|
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 5.0MMX60MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001589
|
|
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 5.0MMX60MM
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.25 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Humana ChoiceCare |
$121.94
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$281.40
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$412.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$234.50
|
|
|
IMPLT SCREW THREAD 5.0MMX60MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001589
|
|
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 5.0MMX60MM
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.20
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$328.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
|
|
IMPLT SCREW THREAD 5.0MMX65MM
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.20
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$328.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
|
|
IMPLT SCREW THREAD 5.0MMX65MM
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.20
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$328.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
|
|
IMPLT SCREW THREAD 5.0MMX65MM
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.25 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Humana ChoiceCare |
$121.94
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$281.40
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$412.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$234.50
|
|
|
IMPLT SCREW THREAD 5.0MMX65MM
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.25 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Humana ChoiceCare |
$121.94
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$281.40
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$412.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$234.50
|
|
|
IMPLT SCREW THREAD 5.0MMX70MM
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.20
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$328.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
|
|
IMPLT SCREW THREAD 5.0MMX70MM
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.25 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Humana ChoiceCare |
$121.94
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$281.40
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$412.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$234.50
|
|
|
IMPLT SCREW,THREAD,5.0MMX70MM
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001068
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.25 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Humana ChoiceCare |
$121.94
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$281.40
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$412.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$234.50
|
|
|
IMPLT SCREW,THREAD,5.0MMX70MM
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001068
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.20
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$328.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
|
|
IMPLT SCREW THREAD 5.0MMX75MM
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.20
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$328.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
|
|
IMPLT SCREW THREAD 5.0MMX75MM
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.25 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Humana ChoiceCare |
$121.94
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$281.40
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$412.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$234.50
|
|
|
IMPLT SCREW THREAD 5.0MMX75MM
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.25 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Humana ChoiceCare |
$121.94
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$281.40
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$412.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$234.50
|
|
|
IMPLT SCREW THREAD 5.0MMX75MM
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.20
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$328.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
|
|
IMPLT SCREW THREAD 5.0MMX80MM
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.20
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$328.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
|
|
IMPLT SCREW THREAD 5.0MMX80MM
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.25 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$398.65
|
| Rate for Payer: First Health Commercial |
$422.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$422.10
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$422.10
|
| Rate for Payer: Humana ChoiceCare |
$121.94
|
| Rate for Payer: Multiplan All |
$426.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$281.40
|
| Rate for Payer: OMNI Networks Commercial |
$328.30
|
| Rate for Payer: One Health Plan PPO/POS |
$422.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$445.55
|
| Rate for Payer: Three Rivers Provider Network All |
$351.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$412.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$436.17
|
| Rate for Payer: Zelis Auto |
$187.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$234.50
|
|
|
IMPLT SCREW THREAD 5.0X40MM
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$491.30
|
| Rate for Payer: First Health Commercial |
$520.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$520.20
|
| Rate for Payer: GEHA Commercial |
$462.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$520.20
|
| Rate for Payer: Humana ChoiceCare |
$150.28
|
| Rate for Payer: Multiplan All |
$525.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$346.80
|
| Rate for Payer: OMNI Networks Commercial |
$404.60
|
| Rate for Payer: One Health Plan PPO/POS |
$520.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$549.10
|
| Rate for Payer: Three Rivers Provider Network All |
$433.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$508.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$144.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$537.54
|
| Rate for Payer: Zelis Auto |
$231.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$289.00
|
|
|
IMPLT SCREW THREAD 5.0X40MM
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.20 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$462.40
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$491.30
|
| Rate for Payer: First Health Commercial |
$520.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$520.20
|
| Rate for Payer: GEHA Commercial |
$404.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$520.20
|
| Rate for Payer: Multiplan All |
$525.98
|
| Rate for Payer: OMNI Networks Commercial |
$404.60
|
| Rate for Payer: One Health Plan PPO/POS |
$520.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$549.10
|
| Rate for Payer: Three Rivers Provider Network All |
$433.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$537.54
|
| Rate for Payer: Zelis Auto |
$231.20
|
|
|
IMPLT SCREW THREAD 5.0X48MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001582
|
|
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 5.0X48MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001582
|
|
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
|
|
