|
IMPLT SCREW THREADED PARTIALLY 4.0X46MM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X50MM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X50MM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X55MM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X55MM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X55MM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X55MM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X60MM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X60MM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X60MM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0X60MM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7005197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0XMM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
|
|
IMPLT SCREW THREADED PARTIALLY 4.0XMM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$170.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
|
|
IMPLT SCREW THREAD LONG 5X48MM
|
Facility
|
IP
|
$1,998.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$799.20 |
| Max. Negotiated Rate |
$1,898.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,598.40
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cigna Commercial |
$1,698.30
|
| Rate for Payer: First Health Commercial |
$1,798.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,798.20
|
| Rate for Payer: GEHA Commercial |
$1,398.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,798.20
|
| Rate for Payer: Multiplan All |
$1,818.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,398.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,798.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,898.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,498.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,858.14
|
| Rate for Payer: Zelis Auto |
$799.20
|
|
|
IMPLT SCREW THREAD LONG 5X48MM
|
Facility
|
OP
|
$1,998.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.50 |
| Max. Negotiated Rate |
$1,898.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,198.80
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cigna Commercial |
$1,698.30
|
| Rate for Payer: First Health Commercial |
$1,798.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,798.20
|
| Rate for Payer: GEHA Commercial |
$1,598.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,798.20
|
| Rate for Payer: Humana ChoiceCare |
$519.48
|
| Rate for Payer: Multiplan All |
$1,818.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,198.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,398.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,798.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,898.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,498.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,758.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$499.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,858.14
|
| Rate for Payer: Zelis Auto |
$799.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$999.00
|
|
|
IMPLT SCREW THREAD LONG 5X50MM
|
Facility
|
OP
|
$1,998.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.50 |
| Max. Negotiated Rate |
$1,898.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,198.80
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cigna Commercial |
$1,698.30
|
| Rate for Payer: First Health Commercial |
$1,798.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,798.20
|
| Rate for Payer: GEHA Commercial |
$1,598.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,798.20
|
| Rate for Payer: Humana ChoiceCare |
$519.48
|
| Rate for Payer: Multiplan All |
$1,818.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,198.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,398.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,798.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,898.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,498.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,758.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$499.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,858.14
|
| Rate for Payer: Zelis Auto |
$799.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$999.00
|
|
|
IMPLT SCREW THREAD LONG 5X50MM
|
Facility
|
IP
|
$1,998.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$799.20 |
| Max. Negotiated Rate |
$1,898.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,598.40
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cigna Commercial |
$1,698.30
|
| Rate for Payer: First Health Commercial |
$1,798.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,798.20
|
| Rate for Payer: GEHA Commercial |
$1,398.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,798.20
|
| Rate for Payer: Multiplan All |
$1,818.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,398.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,798.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,898.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,498.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,858.14
|
| Rate for Payer: Zelis Auto |
$799.20
|
|
|
IMPLT SCREW THREAD LONG 7.0X65MM
|
Facility
|
IP
|
$3,285.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,314.00 |
| Max. Negotiated Rate |
$3,120.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,628.00
|
| Rate for Payer: Cash Price |
$1,971.00
|
| Rate for Payer: Cash Price |
$1,971.00
|
| Rate for Payer: Cigna Commercial |
$2,792.25
|
| Rate for Payer: First Health Commercial |
$2,956.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,956.50
|
| Rate for Payer: GEHA Commercial |
$2,299.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,956.50
|
| Rate for Payer: Multiplan All |
$2,989.35
|
| Rate for Payer: OMNI Networks Commercial |
$2,299.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,956.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,120.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,463.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,055.05
|
| Rate for Payer: Zelis Auto |
$1,314.00
|
|
|
IMPLT SCREW THREAD LONG 7.0X65MM
|
Facility
|
OP
|
$3,285.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$821.25 |
| Max. Negotiated Rate |
$3,120.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,971.00
|
| Rate for Payer: Cash Price |
$1,971.00
|
| Rate for Payer: Cash Price |
$1,971.00
|
| Rate for Payer: Cigna Commercial |
$2,792.25
|
| Rate for Payer: First Health Commercial |
$2,956.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,956.50
|
| Rate for Payer: GEHA Commercial |
$2,628.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,956.50
|
| Rate for Payer: Humana ChoiceCare |
$854.10
|
| Rate for Payer: Multiplan All |
$2,989.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,971.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,299.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,956.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,120.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,463.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,890.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$821.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,055.05
|
| Rate for Payer: Zelis Auto |
$1,314.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,642.50
|
|
|
IMPLT SCREW THREAD LONG 7X45MM
|
Facility
|
IP
|
$3,190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.00 |
| Max. Negotiated Rate |
$3,030.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,552.00
|
| Rate for Payer: Cash Price |
$1,914.00
|
| Rate for Payer: Cash Price |
$1,914.00
|
| Rate for Payer: Cigna Commercial |
$2,711.50
|
| Rate for Payer: First Health Commercial |
$2,871.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,871.00
|
| Rate for Payer: GEHA Commercial |
$2,233.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,871.00
|
| Rate for Payer: Multiplan All |
$2,902.90
|
| Rate for Payer: OMNI Networks Commercial |
$2,233.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,871.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,030.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,392.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,966.70
|
| Rate for Payer: Zelis Auto |
$1,276.00
|
|
|
IMPLT SCREW THREAD LONG 7X45MM
|
Facility
|
OP
|
$3,190.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$3,030.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,914.00
|
| Rate for Payer: Cash Price |
$1,914.00
|
| Rate for Payer: Cash Price |
$1,914.00
|
| Rate for Payer: Cigna Commercial |
$2,711.50
|
| Rate for Payer: First Health Commercial |
$2,871.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,871.00
|
| Rate for Payer: GEHA Commercial |
$2,552.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,871.00
|
| Rate for Payer: Humana ChoiceCare |
$829.40
|
| Rate for Payer: Multiplan All |
$2,902.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,914.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,233.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,871.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,030.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,392.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,807.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$797.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,966.70
|
| Rate for Payer: Zelis Auto |
$1,276.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,595.00
|
|
|
IMPLT SCREW THREAD SHORT 7.0X40MM
|
Facility
|
IP
|
$3,285.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,314.00 |
| Max. Negotiated Rate |
$3,120.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,628.00
|
| Rate for Payer: Cash Price |
$1,971.00
|
| Rate for Payer: Cash Price |
$1,971.00
|
| Rate for Payer: Cigna Commercial |
$2,792.25
|
| Rate for Payer: First Health Commercial |
$2,956.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,956.50
|
| Rate for Payer: GEHA Commercial |
$2,299.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,956.50
|
| Rate for Payer: Multiplan All |
$2,989.35
|
| Rate for Payer: OMNI Networks Commercial |
$2,299.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,956.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,120.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,463.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,055.05
|
| Rate for Payer: Zelis Auto |
$1,314.00
|
|
|
IMPLT SCREW THREAD SHORT 7.0X40MM
|
Facility
|
OP
|
$3,285.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$821.25 |
| Max. Negotiated Rate |
$3,120.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,971.00
|
| Rate for Payer: Cash Price |
$1,971.00
|
| Rate for Payer: Cash Price |
$1,971.00
|
| Rate for Payer: Cigna Commercial |
$2,792.25
|
| Rate for Payer: First Health Commercial |
$2,956.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,956.50
|
| Rate for Payer: GEHA Commercial |
$2,628.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,956.50
|
| Rate for Payer: Humana ChoiceCare |
$854.10
|
| Rate for Payer: Multiplan All |
$2,989.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,971.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,299.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,956.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,120.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,463.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,890.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$821.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,055.05
|
| Rate for Payer: Zelis Auto |
$1,314.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,642.50
|
|
|
IMPLT SCREW THREAD SHORT 7.0X50MM
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.80 |
| Max. Negotiated Rate |
$2,457.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,069.60
|
| Rate for Payer: Cash Price |
$1,552.20
|
| Rate for Payer: Cash Price |
$1,552.20
|
| Rate for Payer: Cigna Commercial |
$2,198.95
|
| Rate for Payer: First Health Commercial |
$2,328.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,328.30
|
| Rate for Payer: GEHA Commercial |
$1,810.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,328.30
|
| Rate for Payer: Multiplan All |
$2,354.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,810.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,328.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,457.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,940.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,405.91
|
| Rate for Payer: Zelis Auto |
$1,034.80
|
|
|
IMPLT SCREW THREAD SHORT 7.0X50MM
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.75 |
| Max. Negotiated Rate |
$2,457.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,552.20
|
| Rate for Payer: Cash Price |
$1,552.20
|
| Rate for Payer: Cash Price |
$1,552.20
|
| Rate for Payer: Cigna Commercial |
$2,198.95
|
| Rate for Payer: First Health Commercial |
$2,328.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,328.30
|
| Rate for Payer: GEHA Commercial |
$2,069.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,328.30
|
| Rate for Payer: Humana ChoiceCare |
$672.62
|
| Rate for Payer: Multiplan All |
$2,354.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,552.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,810.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,328.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,457.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,940.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,276.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$646.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,405.91
|
| Rate for Payer: Zelis Auto |
$1,034.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,293.50
|
|
