|
IMPLT SCREW THREAD 5.0X60MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001583
|
|
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 5.0X60MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001583
|
|
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 6.0MMX12MM
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$406.40
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
|
|
IMPLT SCREW THREAD 6.0MMX12MM
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$132.08
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$304.80
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$447.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$254.00
|
|
|
IMPLT SCREW THREAD 6.0MMX22MM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001073
|
|
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 6.0MMX22MM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001073
|
|
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 THREADED 3/4 6.5X70MM
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.00 |
| Max. Negotiated Rate |
$1,135.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$956.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cigna Commercial |
$1,015.75
|
| Rate for Payer: First Health Commercial |
$1,075.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,075.50
|
| Rate for Payer: GEHA Commercial |
$836.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,075.50
|
| Rate for Payer: Multiplan All |
$1,087.45
|
| Rate for Payer: OMNI Networks Commercial |
$836.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,075.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,135.25
|
| Rate for Payer: Three Rivers Provider Network All |
$896.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,111.35
|
| Rate for Payer: Zelis Auto |
$478.00
|
|
|
IMPLT SCREW THREADED 3/4 6.5X70MM
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.75 |
| Max. Negotiated Rate |
$1,135.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$717.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cigna Commercial |
$1,015.75
|
| Rate for Payer: First Health Commercial |
$1,075.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,075.50
|
| Rate for Payer: GEHA Commercial |
$956.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,075.50
|
| Rate for Payer: Humana ChoiceCare |
$310.70
|
| Rate for Payer: Multiplan All |
$1,087.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$717.00
|
| Rate for Payer: OMNI Networks Commercial |
$836.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,075.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,135.25
|
| Rate for Payer: Three Rivers Provider Network All |
$896.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,051.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$298.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,111.35
|
| Rate for Payer: Zelis Auto |
$478.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$597.50
|
|
|
IMPLT SCREW THREADED 6.5X50MM
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.00 |
| Max. Negotiated Rate |
$1,448.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,220.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$1,296.25
|
| Rate for Payer: First Health Commercial |
$1,372.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,372.50
|
| Rate for Payer: GEHA Commercial |
$1,067.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,372.50
|
| Rate for Payer: Multiplan All |
$1,387.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,067.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,372.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,448.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,418.25
|
| Rate for Payer: Zelis Auto |
$610.00
|
|
|
IMPLT SCREW THREADED 6.5X50MM
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$381.25 |
| Max. Negotiated Rate |
$1,448.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$1,296.25
|
| Rate for Payer: First Health Commercial |
$1,372.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,372.50
|
| Rate for Payer: GEHA Commercial |
$1,220.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,372.50
|
| Rate for Payer: Humana ChoiceCare |
$396.50
|
| Rate for Payer: Multiplan All |
$1,387.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$915.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,067.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,372.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,448.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,342.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$381.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,418.25
|
| Rate for Payer: Zelis Auto |
$610.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$762.50
|
|
|
IMPLT SCREW THREADED FULL 2.7X28MM
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.00 |
| Max. Negotiated Rate |
$619.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cigna Commercial |
$554.20
|
| Rate for Payer: First Health Commercial |
$586.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$586.80
|
| Rate for Payer: GEHA Commercial |
$521.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.80
|
| Rate for Payer: Humana ChoiceCare |
$169.52
|
| Rate for Payer: Multiplan All |
$593.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$391.20
|
| Rate for Payer: OMNI Networks Commercial |
$456.40
|
| Rate for Payer: One Health Plan PPO/POS |
$586.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$619.40
|
| Rate for Payer: Three Rivers Provider Network All |
$489.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$573.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$163.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$606.36
|
| Rate for Payer: Zelis Auto |
$260.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$326.00
|
|
|
IMPLT SCREW THREADED FULL 2.7X28MM
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$260.80 |
| Max. Negotiated Rate |
$619.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$521.60
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cigna Commercial |
$554.20
|
| Rate for Payer: First Health Commercial |
$586.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$586.80
|
| Rate for Payer: GEHA Commercial |
$456.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.80
|
| Rate for Payer: Multiplan All |
$593.32
|
| Rate for Payer: OMNI Networks Commercial |
$456.40
|
| Rate for Payer: One Health Plan PPO/POS |
$586.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$619.40
|
| Rate for Payer: Three Rivers Provider Network All |
$489.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$606.36
|
| Rate for Payer: Zelis Auto |
$260.80
|
|
|
IMPLT SCREW THREADED FULL 5X47.5MM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW THREADED FULL 5X47.5MM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW THREADED FULL 5X57,5MM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$718.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Humana ChoiceCare |
$233.48
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$538.80
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$790.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$449.00
|
|
|
IMPLT SCREW THREADED FULL 5X57,5MM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$718.40
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$763.30
|
| Rate for Payer: First Health Commercial |
$808.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$808.20
|
| Rate for Payer: GEHA Commercial |
$628.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$808.20
|
| Rate for Payer: Multiplan All |
$817.18
|
| Rate for Payer: OMNI Networks Commercial |
$628.60
|
| Rate for Payer: One Health Plan PPO/POS |
$808.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$853.10
|
| Rate for Payer: Three Rivers Provider Network All |
$673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$835.14
|
| Rate for Payer: Zelis Auto |
$359.20
|
|
|
IMPLT SCREW THREADED PART
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$844.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$738.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
|
|
IMPLT SCREW THREADED PART
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.75 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$844.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Humana ChoiceCare |
$274.30
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$633.00
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$928.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.50
|
|
|
IMPLT SCREW THREADED PARTIAlALLY
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$844.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$738.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
|
|
IMPLT SCREW THREADED PARTIAlALLY
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.75 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$844.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Humana ChoiceCare |
$274.30
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$633.00
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$928.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.50
|
|
|
IMPLT SCREW THREADED PARTIALLY
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.75 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$844.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Humana ChoiceCare |
$274.30
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$633.00
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$928.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.50
|
|
|
IMPLT SCREW THREADED PARTIALLY
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.75 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$844.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Humana ChoiceCare |
$274.30
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$633.00
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$928.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.50
|
|
|
IMPLT SCREW THREADED PARTIALLY
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.75 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$844.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Humana ChoiceCare |
$274.30
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$633.00
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$928.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$527.50
|
|
|
IMPLT SCREW THREADED PARTIALLY
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$844.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$738.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
|
|
IMPLT SCREW THREADED PARTIALLY
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$844.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$738.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
|
