|
IMPLT ACCORD 115MM TROCHANTRIC GRIP
|
Facility
|
OP
|
$5,381.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,345.25 |
| Max. Negotiated Rate |
$5,111.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,228.60
|
| Rate for Payer: Cash Price |
$3,228.60
|
| Rate for Payer: Cash Price |
$3,228.60
|
| Rate for Payer: Cigna Commercial |
$4,573.85
|
| Rate for Payer: First Health Commercial |
$4,842.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,842.90
|
| Rate for Payer: GEHA Commercial |
$4,304.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,842.90
|
| Rate for Payer: Humana ChoiceCare |
$1,399.06
|
| Rate for Payer: Multiplan All |
$4,896.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,228.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,766.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,842.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,111.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,035.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,735.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,345.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,004.33
|
| Rate for Payer: Zelis Auto |
$2,152.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,690.50
|
|
|
IMPLT ACCORD 125MM TROCHANTRIC GRIP
|
Facility
|
OP
|
$11,608.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,902.00 |
| Max. Negotiated Rate |
$11,027.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,964.80
|
| Rate for Payer: Cash Price |
$6,964.80
|
| Rate for Payer: Cash Price |
$6,964.80
|
| Rate for Payer: Cigna Commercial |
$9,866.80
|
| Rate for Payer: First Health Commercial |
$10,447.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,447.20
|
| Rate for Payer: GEHA Commercial |
$9,286.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,447.20
|
| Rate for Payer: Humana ChoiceCare |
$3,018.08
|
| Rate for Payer: Multiplan All |
$10,563.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,964.80
|
| Rate for Payer: OMNI Networks Commercial |
$8,125.60
|
| Rate for Payer: One Health Plan PPO/POS |
$10,447.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,027.60
|
| Rate for Payer: Three Rivers Provider Network All |
$8,706.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,215.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,902.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,795.44
|
| Rate for Payer: Zelis Auto |
$4,643.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,804.00
|
|
|
IMPLT ACCORD 125MM TROCHANTRIC GRIP
|
Facility
|
IP
|
$11,608.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,643.20 |
| Max. Negotiated Rate |
$11,027.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,286.40
|
| Rate for Payer: Cash Price |
$6,964.80
|
| Rate for Payer: Cash Price |
$6,964.80
|
| Rate for Payer: Cigna Commercial |
$9,866.80
|
| Rate for Payer: First Health Commercial |
$10,447.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,447.20
|
| Rate for Payer: GEHA Commercial |
$8,125.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,447.20
|
| Rate for Payer: Multiplan All |
$10,563.28
|
| Rate for Payer: OMNI Networks Commercial |
$8,125.60
|
| Rate for Payer: One Health Plan PPO/POS |
$10,447.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,027.60
|
| Rate for Payer: Three Rivers Provider Network All |
$8,706.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,795.44
|
| Rate for Payer: Zelis Auto |
$4,643.20
|
|
|
IMPLT ACCORD 2.0MM CABLE W/CLAMP
|
Facility
|
OP
|
$2,839.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.75 |
| Max. Negotiated Rate |
$2,697.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,703.40
|
| Rate for Payer: Cash Price |
$1,703.40
|
| Rate for Payer: Cash Price |
$1,703.40
|
| Rate for Payer: Cigna Commercial |
$2,413.15
|
| Rate for Payer: First Health Commercial |
$2,555.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,555.10
|
| Rate for Payer: GEHA Commercial |
$2,271.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,555.10
|
| Rate for Payer: Humana ChoiceCare |
$738.14
|
| Rate for Payer: Multiplan All |
$2,583.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,703.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,987.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,555.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,697.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,129.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,498.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$709.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,640.27
|
| Rate for Payer: Zelis Auto |
$1,135.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,419.50
|
|
|
IMPLT ACCORD 2.0MM CABLE W/CLAMP
|
Facility
|
IP
|
$2,839.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,135.60 |
| Max. Negotiated Rate |
$2,697.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,271.20
|
| Rate for Payer: Cash Price |
$1,703.40
|
| Rate for Payer: Cash Price |
$1,703.40
|
| Rate for Payer: Cigna Commercial |
$2,413.15
|
| Rate for Payer: First Health Commercial |
$2,555.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,555.10
|
| Rate for Payer: GEHA Commercial |
$1,987.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,555.10
|
| Rate for Payer: Multiplan All |
$2,583.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,987.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,555.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,697.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,129.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,640.27
|
| Rate for Payer: Zelis Auto |
$1,135.60
|
|
|
IMPLT ACCORD 2.0MM CABLE W/CLAMP
|
Facility
|
IP
|
$1,188.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.20 |
| Max. Negotiated Rate |
$1,128.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$950.40
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cigna Commercial |
$1,009.80
|
| Rate for Payer: First Health Commercial |
$1,069.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,069.20
|
| Rate for Payer: GEHA Commercial |
$831.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,069.20
|
| Rate for Payer: Multiplan All |
$1,081.08
|
| Rate for Payer: OMNI Networks Commercial |
$831.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,069.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,128.60
|
| Rate for Payer: Three Rivers Provider Network All |
$891.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,104.84
|
| Rate for Payer: Zelis Auto |
$475.20
|
|
|
IMPLT ACCORD 2.0MM CABLE W/CLAMP
|
Facility
|
OP
|
$1,188.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,128.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cigna Commercial |
$1,009.80
|
| Rate for Payer: First Health Commercial |
$1,069.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,069.20
|
| Rate for Payer: GEHA Commercial |
$950.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,069.20
|
| Rate for Payer: Humana ChoiceCare |
$308.88
|
| Rate for Payer: Multiplan All |
$1,081.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$712.80
|
| Rate for Payer: OMNI Networks Commercial |
$831.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,069.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,128.60
|
| Rate for Payer: Three Rivers Provider Network All |
$891.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,045.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$297.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,104.84
|
| Rate for Payer: Zelis Auto |
$475.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$594.00
|
|
|
IMPLT ACETABULAR SHELL CLUSTERHOLE
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.00 |
| Max. Negotiated Rate |
$3,287.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cigna Commercial |
$2,941.00
|
| Rate for Payer: First Health Commercial |
$3,114.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,114.00
|
| Rate for Payer: GEHA Commercial |
$2,768.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,114.00
|
| Rate for Payer: Humana ChoiceCare |
$899.60
|
| Rate for Payer: Multiplan All |
$3,148.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,076.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,422.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,114.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,287.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,595.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,044.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$865.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,217.80
|
| Rate for Payer: Zelis Auto |
$1,384.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,730.00
|
|
|
IMPLT ACETABULAR SHELL CLUSTERHOLE
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.00 |
| Max. Negotiated Rate |
$3,287.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,768.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cigna Commercial |
$2,941.00
|
| Rate for Payer: First Health Commercial |
$3,114.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,114.00
|
| Rate for Payer: GEHA Commercial |
$2,422.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,114.00
|
| Rate for Payer: Multiplan All |
$3,148.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,422.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,114.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,287.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,595.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,217.80
|
| Rate for Payer: Zelis Auto |
$1,384.00
|
|
|
IMPLT ACETABULAR SHELL CLUSTERHOLE
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.00 |
| Max. Negotiated Rate |
$3,287.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,768.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cigna Commercial |
$2,941.00
|
| Rate for Payer: First Health Commercial |
$3,114.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,114.00
|
| Rate for Payer: GEHA Commercial |
$2,422.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,114.00
|
| Rate for Payer: Multiplan All |
$3,148.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,422.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,114.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,287.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,595.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,217.80
|
| Rate for Payer: Zelis Auto |
$1,384.00
|
|
|
IMPLT ACETABULAR SHELL CLUSTERHOLE
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.00 |
| Max. Negotiated Rate |
$3,287.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cigna Commercial |
$2,941.00
|
| Rate for Payer: First Health Commercial |
$3,114.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,114.00
|
| Rate for Payer: GEHA Commercial |
$2,768.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,114.00
|
| Rate for Payer: Humana ChoiceCare |
$899.60
|
| Rate for Payer: Multiplan All |
$3,148.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,076.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,422.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,114.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,287.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,595.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,044.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$865.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,217.80
|
| Rate for Payer: Zelis Auto |
$1,384.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,730.00
|
|
|
IMPLT ACETABULAR SHELL CLUSTERHOLE
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.00 |
| Max. Negotiated Rate |
$3,287.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cigna Commercial |
$2,941.00
|
| Rate for Payer: First Health Commercial |
$3,114.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,114.00
|
| Rate for Payer: GEHA Commercial |
$2,768.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,114.00
|
| Rate for Payer: Humana ChoiceCare |
$899.60
|
| Rate for Payer: Multiplan All |
$3,148.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,076.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,422.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,114.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,287.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,595.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,044.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$865.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,217.80
|
| Rate for Payer: Zelis Auto |
$1,384.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,730.00
|
|
|
IMPLT ACETABULAR SHELL CLUSTERHOLE
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.00 |
| Max. Negotiated Rate |
$3,287.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,768.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cigna Commercial |
$2,941.00
|
| Rate for Payer: First Health Commercial |
$3,114.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,114.00
|
| Rate for Payer: GEHA Commercial |
$2,422.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,114.00
|
| Rate for Payer: Multiplan All |
$3,148.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,422.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,114.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,287.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,595.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,217.80
|
| Rate for Payer: Zelis Auto |
$1,384.00
|
|
|
IMPLT ADAPTER LENGTH NECK HIP STANDARD
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,305.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,099.20
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$961.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| Rate for Payer: Multiplan All |
$1,250.34
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,305.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,277.82
|
| Rate for Payer: Zelis Auto |
$549.60
|
|
|
IMPLT ADAPTER LENGTH NECK HIP STANDARD
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.50 |
| Max. Negotiated Rate |
$1,305.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$1,099.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| Rate for Payer: Humana ChoiceCare |
$357.24
|
| Rate for Payer: Multiplan All |
$1,250.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$824.40
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,305.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,209.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$343.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,277.82
|
| Rate for Payer: Zelis Auto |
$549.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$687.00
|
|
|
IMPLT ADAPTER NECK HIP S1S +6MM
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,305.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,099.20
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$961.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| Rate for Payer: Multiplan All |
$1,250.34
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,305.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,277.82
|
| Rate for Payer: Zelis Auto |
$549.60
|
|
|
IMPLT ADAPTER NECK HIP S1S +6MM
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.50 |
| Max. Negotiated Rate |
$1,305.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$1,099.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| Rate for Payer: Humana ChoiceCare |
$357.24
|
| Rate for Payer: Multiplan All |
$1,250.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$824.40
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,305.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,209.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$343.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,277.82
|
| Rate for Payer: Zelis Auto |
$549.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$687.00
|
|
|
IMPLT ADAPTER OFFSET 2MM TRIATHLON
|
Facility
|
OP
|
$3,755.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.75 |
| Max. Negotiated Rate |
$3,567.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,253.00
|
| Rate for Payer: Cash Price |
$2,253.00
|
| Rate for Payer: Cash Price |
$2,253.00
|
| Rate for Payer: Cigna Commercial |
$3,191.75
|
| Rate for Payer: First Health Commercial |
$3,379.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,379.50
|
| Rate for Payer: GEHA Commercial |
$3,004.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,379.50
|
| Rate for Payer: Humana ChoiceCare |
$976.30
|
| Rate for Payer: Multiplan All |
$3,417.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,253.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,628.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,379.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,567.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,816.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,304.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$938.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,492.15
|
| Rate for Payer: Zelis Auto |
$1,502.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,877.50
|
|
|
IMPLT ADAPTER OFFSET 2MM TRIATHLON
|
Facility
|
IP
|
$3,755.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.00 |
| Max. Negotiated Rate |
$3,567.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,004.00
|
| Rate for Payer: Cash Price |
$2,253.00
|
| Rate for Payer: Cash Price |
$2,253.00
|
| Rate for Payer: Cigna Commercial |
$3,191.75
|
| Rate for Payer: First Health Commercial |
$3,379.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,379.50
|
| Rate for Payer: GEHA Commercial |
$2,628.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,379.50
|
| Rate for Payer: Multiplan All |
$3,417.05
|
| Rate for Payer: OMNI Networks Commercial |
$2,628.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,379.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,567.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,816.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,492.15
|
| Rate for Payer: Zelis Auto |
$1,502.00
|
|
|
IMPLT ADAPTER OFFSET 36MM+3MM
|
Facility
|
IP
|
$4,415.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,766.00 |
| Max. Negotiated Rate |
$4,194.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,532.00
|
| Rate for Payer: Cash Price |
$2,649.00
|
| Rate for Payer: Cash Price |
$2,649.00
|
| Rate for Payer: Cigna Commercial |
$3,752.75
|
| Rate for Payer: First Health Commercial |
$3,973.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,973.50
|
| Rate for Payer: GEHA Commercial |
$3,090.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,973.50
|
| Rate for Payer: Multiplan All |
$4,017.65
|
| Rate for Payer: OMNI Networks Commercial |
$3,090.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,973.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,194.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,311.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,105.95
|
| Rate for Payer: Zelis Auto |
$1,766.00
|
|
|
IMPLT ADAPTER OFFSET 36MM+3MM
|
Facility
|
OP
|
$4,415.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,103.75 |
| Max. Negotiated Rate |
$4,194.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,649.00
|
| Rate for Payer: Cash Price |
$2,649.00
|
| Rate for Payer: Cash Price |
$2,649.00
|
| Rate for Payer: Cigna Commercial |
$3,752.75
|
| Rate for Payer: First Health Commercial |
$3,973.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,973.50
|
| Rate for Payer: GEHA Commercial |
$3,532.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,973.50
|
| Rate for Payer: Humana ChoiceCare |
$1,147.90
|
| Rate for Payer: Multiplan All |
$4,017.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,649.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,090.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,973.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,194.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,311.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,885.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,103.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,105.95
|
| Rate for Payer: Zelis Auto |
$1,766.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,207.50
|
|
|
IMPLT ADAPTER OFFSET 4MM
|
Facility
|
IP
|
$3,681.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.40 |
| Max. Negotiated Rate |
$3,496.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,944.80
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cigna Commercial |
$3,128.85
|
| Rate for Payer: First Health Commercial |
$3,312.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,312.90
|
| Rate for Payer: GEHA Commercial |
$2,576.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,312.90
|
| Rate for Payer: Multiplan All |
$3,349.71
|
| Rate for Payer: OMNI Networks Commercial |
$2,576.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,312.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,496.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,760.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,423.33
|
| Rate for Payer: Zelis Auto |
$1,472.40
|
|
|
IMPLT ADAPTER OFFSET 4MM
|
Facility
|
OP
|
$3,681.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.25 |
| Max. Negotiated Rate |
$3,496.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,208.60
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cigna Commercial |
$3,128.85
|
| Rate for Payer: First Health Commercial |
$3,312.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,312.90
|
| Rate for Payer: GEHA Commercial |
$2,944.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,312.90
|
| Rate for Payer: Humana ChoiceCare |
$957.06
|
| Rate for Payer: Multiplan All |
$3,349.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,208.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,576.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,312.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,496.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,760.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,239.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$920.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,423.33
|
| Rate for Payer: Zelis Auto |
$1,472.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,840.50
|
|
|
IMPLT ADAPTER OFFSET 8MM
|
Facility
|
IP
|
$3,748.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.20 |
| Max. Negotiated Rate |
$3,560.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,998.40
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Cigna Commercial |
$3,185.80
|
| Rate for Payer: First Health Commercial |
$3,373.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,373.20
|
| Rate for Payer: GEHA Commercial |
$2,623.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,373.20
|
| Rate for Payer: Multiplan All |
$3,410.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,623.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,373.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,560.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,811.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,485.64
|
| Rate for Payer: Zelis Auto |
$1,499.20
|
|
|
IMPLT ADAPTER OFFSET 8MM
|
Facility
|
OP
|
$3,748.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.00 |
| Max. Negotiated Rate |
$3,560.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,248.80
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Cigna Commercial |
$3,185.80
|
| Rate for Payer: First Health Commercial |
$3,373.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,373.20
|
| Rate for Payer: GEHA Commercial |
$2,998.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,373.20
|
| Rate for Payer: Humana ChoiceCare |
$974.48
|
| Rate for Payer: Multiplan All |
$3,410.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,248.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,623.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,373.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,560.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,811.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,298.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$937.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,485.64
|
| Rate for Payer: Zelis Auto |
$1,499.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,874.00
|
|
