|
IMPLT ADAPTER OFFSET TRIATHLON 4MM
|
Facility
|
IP
|
$3,681.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006147
|
|
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 TRIATHLON 4MM
|
Facility
|
OP
|
$3,681.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006147
|
|
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 TRIATHLON 6MM
|
Facility
|
OP
|
$3,755.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002675
|
|
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 TRIATHLON 6MM
|
Facility
|
IP
|
$3,755.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002675
|
|
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 TIBIAL TRAY OFFSET 5.0
|
Facility
|
IP
|
$8,885.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,554.00 |
| Max. Negotiated Rate |
$8,440.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,108.00
|
| Rate for Payer: Cash Price |
$5,331.00
|
| Rate for Payer: Cash Price |
$5,331.00
|
| Rate for Payer: Cigna Commercial |
$7,552.25
|
| Rate for Payer: First Health Commercial |
$7,996.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,996.50
|
| Rate for Payer: GEHA Commercial |
$6,219.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,996.50
|
| Rate for Payer: Multiplan All |
$8,085.35
|
| Rate for Payer: OMNI Networks Commercial |
$6,219.50
|
| Rate for Payer: One Health Plan PPO/POS |
$7,996.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,440.75
|
| Rate for Payer: Three Rivers Provider Network All |
$6,663.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,263.05
|
| Rate for Payer: Zelis Auto |
$3,554.00
|
|
|
IMPLT ADAPTER TIBIAL TRAY OFFSET 5.0
|
Facility
|
OP
|
$8,885.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,221.25 |
| Max. Negotiated Rate |
$8,440.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,331.00
|
| Rate for Payer: Cash Price |
$5,331.00
|
| Rate for Payer: Cash Price |
$5,331.00
|
| Rate for Payer: Cigna Commercial |
$7,552.25
|
| Rate for Payer: First Health Commercial |
$7,996.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,996.50
|
| Rate for Payer: GEHA Commercial |
$7,108.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,996.50
|
| Rate for Payer: Humana ChoiceCare |
$2,310.10
|
| Rate for Payer: Multiplan All |
$8,085.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,331.00
|
| Rate for Payer: OMNI Networks Commercial |
$6,219.50
|
| Rate for Payer: One Health Plan PPO/POS |
$7,996.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,440.75
|
| Rate for Payer: Three Rivers Provider Network All |
$6,663.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,818.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,221.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,263.05
|
| Rate for Payer: Zelis Auto |
$3,554.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,442.50
|
|
|
IMPLT ADAPTOR TAPER STANDARD
|
Facility
|
IP
|
$1,066.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.40 |
| Max. Negotiated Rate |
$1,012.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$852.80
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cigna Commercial |
$906.10
|
| Rate for Payer: First Health Commercial |
$959.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$959.40
|
| Rate for Payer: GEHA Commercial |
$746.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$959.40
|
| Rate for Payer: Multiplan All |
$970.06
|
| Rate for Payer: OMNI Networks Commercial |
$746.20
|
| Rate for Payer: One Health Plan PPO/POS |
$959.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,012.70
|
| Rate for Payer: Three Rivers Provider Network All |
$799.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$991.38
|
| Rate for Payer: Zelis Auto |
$426.40
|
|
|
IMPLT ADAPTOR TAPER STANDARD
|
Facility
|
OP
|
$1,066.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,012.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$639.60
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cash Price |
$639.60
|
| Rate for Payer: Cigna Commercial |
$906.10
|
| Rate for Payer: First Health Commercial |
$959.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$959.40
|
| Rate for Payer: GEHA Commercial |
$852.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$959.40
|
| Rate for Payer: Humana ChoiceCare |
$277.16
|
| Rate for Payer: Multiplan All |
$970.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$639.60
|
| Rate for Payer: OMNI Networks Commercial |
$746.20
|
| Rate for Payer: One Health Plan PPO/POS |
$959.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,012.70
|
| Rate for Payer: Three Rivers Provider Network All |
$799.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$938.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$991.38
|
| Rate for Payer: Zelis Auto |
$426.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$533.00
|
|
|
IMPLT AIMER ENDO FEMORAL OFFSET 6MM
|
Facility
|
IP
|
$2,012.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.80 |
| Max. Negotiated Rate |
$1,911.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,609.60
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Cigna Commercial |
$1,710.20
|
| Rate for Payer: First Health Commercial |
$1,810.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,810.80
|
| Rate for Payer: GEHA Commercial |
$1,408.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,810.80
|
| Rate for Payer: Multiplan All |
$1,830.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,408.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,810.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,911.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,509.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,871.16
|
| Rate for Payer: Zelis Auto |
$804.80
|
|
|
IMPLT AIMER ENDO FEMORAL OFFSET 6MM
|
Facility
|
OP
|
$2,012.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$503.00 |
| Max. Negotiated Rate |
$1,911.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,207.20
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Cigna Commercial |
$1,710.20
|
| Rate for Payer: First Health Commercial |
$1,810.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,810.80
|
| Rate for Payer: GEHA Commercial |
$1,609.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,810.80
|
| Rate for Payer: Humana ChoiceCare |
$523.12
|
| Rate for Payer: Multiplan All |
$1,830.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,207.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,408.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,810.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,911.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,509.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,770.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$503.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,871.16
|
| Rate for Payer: Zelis Auto |
$804.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,006.00
|
|
|
IMPLT AIMER ENDO FEMORAL OFFSET 7MM
|
Facility
|
IP
|
$2,012.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.80 |
| Max. Negotiated Rate |
$1,911.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,609.60
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Cigna Commercial |
$1,710.20
|
| Rate for Payer: First Health Commercial |
$1,810.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,810.80
|
| Rate for Payer: GEHA Commercial |
$1,408.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,810.80
|
| Rate for Payer: Multiplan All |
$1,830.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,408.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,810.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,911.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,509.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,871.16
|
| Rate for Payer: Zelis Auto |
$804.80
|
|
|
IMPLT AIMER ENDO FEMORAL OFFSET 7MM
|
Facility
|
OP
|
$2,012.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$503.00 |
| Max. Negotiated Rate |
$1,911.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,207.20
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Cigna Commercial |
$1,710.20
|
| Rate for Payer: First Health Commercial |
$1,810.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,810.80
|
| Rate for Payer: GEHA Commercial |
$1,609.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,810.80
|
| Rate for Payer: Humana ChoiceCare |
$523.12
|
| Rate for Payer: Multiplan All |
$1,830.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,207.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,408.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,810.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,911.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,509.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,770.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$503.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,871.16
|
| Rate for Payer: Zelis Auto |
$804.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,006.00
|
|
|
IMPLT ALLOGRAFT BTB PRESHAPED
|
Facility
|
IP
|
$15,920.88
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,368.35 |
| Max. Negotiated Rate |
$15,124.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,736.70
|
| Rate for Payer: Cash Price |
$9,552.53
|
| Rate for Payer: Cash Price |
$9,552.53
|
| Rate for Payer: Cigna Commercial |
$13,532.75
|
| Rate for Payer: First Health Commercial |
$14,328.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,328.79
|
| Rate for Payer: GEHA Commercial |
$11,144.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,328.79
|
| Rate for Payer: Multiplan All |
$14,488.00
|
| Rate for Payer: OMNI Networks Commercial |
$11,144.62
|
| Rate for Payer: One Health Plan PPO/POS |
$14,328.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,124.84
|
| Rate for Payer: Three Rivers Provider Network All |
$11,940.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,806.42
|
| Rate for Payer: Zelis Auto |
$6,368.35
|
|
|
IMPLT ALLOGRAFT BTB PRESHAPED
|
Facility
|
OP
|
$15,920.88
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,980.22 |
| Max. Negotiated Rate |
$15,124.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,552.53
|
| Rate for Payer: Cash Price |
$9,552.53
|
| Rate for Payer: Cash Price |
$9,552.53
|
| Rate for Payer: Cigna Commercial |
$13,532.75
|
| Rate for Payer: First Health Commercial |
$14,328.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14,328.79
|
| Rate for Payer: GEHA Commercial |
$12,736.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14,328.79
|
| Rate for Payer: Humana ChoiceCare |
$4,139.43
|
| Rate for Payer: Multiplan All |
$14,488.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,552.53
|
| Rate for Payer: OMNI Networks Commercial |
$11,144.62
|
| Rate for Payer: One Health Plan PPO/POS |
$14,328.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15,124.84
|
| Rate for Payer: Three Rivers Provider Network All |
$11,940.66
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14,010.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,980.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,806.42
|
| Rate for Payer: Zelis Auto |
$6,368.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,960.44
|
|
|
IMPLT ALLOGRAFT DBM PUTTY 10CC
|
Facility
|
IP
|
$3,928.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.20 |
| Max. Negotiated Rate |
$3,731.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,142.40
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cigna Commercial |
$3,338.80
|
| Rate for Payer: First Health Commercial |
$3,535.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,535.20
|
| Rate for Payer: GEHA Commercial |
$2,749.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,535.20
|
| Rate for Payer: Multiplan All |
$3,574.48
|
| Rate for Payer: OMNI Networks Commercial |
$2,749.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,535.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,731.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,946.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,653.04
|
| Rate for Payer: Zelis Auto |
$1,571.20
|
|
|
IMPLT ALLOGRAFT DBM PUTTY 10CC
|
Facility
|
OP
|
$3,928.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.00 |
| Max. Negotiated Rate |
$3,731.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,356.80
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cigna Commercial |
$3,338.80
|
| Rate for Payer: First Health Commercial |
$3,535.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,535.20
|
| Rate for Payer: GEHA Commercial |
$3,142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,535.20
|
| Rate for Payer: Humana ChoiceCare |
$1,021.28
|
| Rate for Payer: Multiplan All |
$3,574.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,356.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,749.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,535.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,731.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,946.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,456.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$982.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,653.04
|
| Rate for Payer: Zelis Auto |
$1,571.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,964.00
|
|
|
IMPLT ALLOGRAFT DBM PUTTY 5CC
|
Facility
|
OP
|
$2,686.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.50 |
| Max. Negotiated Rate |
$2,551.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,611.60
|
| Rate for Payer: Cash Price |
$1,611.60
|
| Rate for Payer: Cash Price |
$1,611.60
|
| Rate for Payer: Cigna Commercial |
$2,283.10
|
| Rate for Payer: First Health Commercial |
$2,417.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,417.40
|
| Rate for Payer: GEHA Commercial |
$2,148.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,417.40
|
| Rate for Payer: Humana ChoiceCare |
$698.36
|
| Rate for Payer: Multiplan All |
$2,444.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,611.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,880.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,417.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,551.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,014.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,363.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$671.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,497.98
|
| Rate for Payer: Zelis Auto |
$1,074.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.00
|
|
|
IMPLT ALLOGRAFT DBM PUTTY 5CC
|
Facility
|
IP
|
$2,686.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,074.40 |
| Max. Negotiated Rate |
$2,551.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,148.80
|
| Rate for Payer: Cash Price |
$1,611.60
|
| Rate for Payer: Cash Price |
$1,611.60
|
| Rate for Payer: Cigna Commercial |
$2,283.10
|
| Rate for Payer: First Health Commercial |
$2,417.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,417.40
|
| Rate for Payer: GEHA Commercial |
$1,880.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,417.40
|
| Rate for Payer: Multiplan All |
$2,444.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,880.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,417.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,551.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,014.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,497.98
|
| Rate for Payer: Zelis Auto |
$1,074.40
|
|
|
IMPLT ALLOGRAFT FEMORAL SHAFT BISECTED
|
Facility
|
IP
|
$3,549.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.60 |
| Max. Negotiated Rate |
$3,371.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,839.20
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cigna Commercial |
$3,016.65
|
| Rate for Payer: First Health Commercial |
$3,194.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,194.10
|
| Rate for Payer: GEHA Commercial |
$2,484.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,194.10
|
| Rate for Payer: Multiplan All |
$3,229.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,484.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,194.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,371.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,661.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,300.57
|
| Rate for Payer: Zelis Auto |
$1,419.60
|
|
|
IMPLT ALLOGRAFT FEMORAL SHAFT BISECTED
|
Facility
|
OP
|
$3,549.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.25 |
| Max. Negotiated Rate |
$3,371.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,129.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cigna Commercial |
$3,016.65
|
| Rate for Payer: First Health Commercial |
$3,194.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,194.10
|
| Rate for Payer: GEHA Commercial |
$2,839.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,194.10
|
| Rate for Payer: Humana ChoiceCare |
$922.74
|
| Rate for Payer: Multiplan All |
$3,229.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,129.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,484.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,194.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,371.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,661.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,123.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$887.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,300.57
|
| Rate for Payer: Zelis Auto |
$1,419.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,774.50
|
|
|
IMPLT ALLOGRAFT PATELLA TENDON
|
Facility
|
IP
|
$10,670.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7005213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,268.00 |
| Max. Negotiated Rate |
$10,136.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,536.00
|
| Rate for Payer: Cash Price |
$6,402.00
|
| Rate for Payer: Cash Price |
$6,402.00
|
| Rate for Payer: Cigna Commercial |
$9,069.50
|
| Rate for Payer: First Health Commercial |
$9,603.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,603.00
|
| Rate for Payer: GEHA Commercial |
$7,469.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,603.00
|
| Rate for Payer: Multiplan All |
$9,709.70
|
| Rate for Payer: OMNI Networks Commercial |
$7,469.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9,603.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,136.50
|
| Rate for Payer: Three Rivers Provider Network All |
$8,002.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,923.10
|
| Rate for Payer: Zelis Auto |
$4,268.00
|
|
|
IMPLT ALLOGRAFT PATELLA TENDON
|
Facility
|
OP
|
$10,191.51
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,547.88 |
| Max. Negotiated Rate |
$9,681.93 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,114.91
|
| Rate for Payer: Cash Price |
$6,114.91
|
| Rate for Payer: Cash Price |
$6,114.91
|
| Rate for Payer: Cigna Commercial |
$8,662.78
|
| Rate for Payer: First Health Commercial |
$9,172.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,172.36
|
| Rate for Payer: GEHA Commercial |
$8,153.21
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,172.36
|
| Rate for Payer: Humana ChoiceCare |
$2,649.79
|
| Rate for Payer: Multiplan All |
$9,274.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,114.91
|
| Rate for Payer: OMNI Networks Commercial |
$7,134.06
|
| Rate for Payer: One Health Plan PPO/POS |
$9,172.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,681.93
|
| Rate for Payer: Three Rivers Provider Network All |
$7,643.63
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,968.53
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,547.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,478.10
|
| Rate for Payer: Zelis Auto |
$4,076.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,095.76
|
|
|
IMPLT ALLOGRAFT PATELLA TENDON
|
Facility
|
IP
|
$10,191.51
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,076.60 |
| Max. Negotiated Rate |
$9,681.93 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,153.21
|
| Rate for Payer: Cash Price |
$6,114.91
|
| Rate for Payer: Cash Price |
$6,114.91
|
| Rate for Payer: Cigna Commercial |
$8,662.78
|
| Rate for Payer: First Health Commercial |
$9,172.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,172.36
|
| Rate for Payer: GEHA Commercial |
$7,134.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,172.36
|
| Rate for Payer: Multiplan All |
$9,274.27
|
| Rate for Payer: OMNI Networks Commercial |
$7,134.06
|
| Rate for Payer: One Health Plan PPO/POS |
$9,172.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,681.93
|
| Rate for Payer: Three Rivers Provider Network All |
$7,643.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,478.10
|
| Rate for Payer: Zelis Auto |
$4,076.60
|
|
|
IMPLT ALLOGRAFT PATELLA TENDON
|
Facility
|
IP
|
$9,209.64
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.86 |
| Max. Negotiated Rate |
$8,749.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,367.71
|
| Rate for Payer: Cash Price |
$5,525.78
|
| Rate for Payer: Cash Price |
$5,525.78
|
| Rate for Payer: Cigna Commercial |
$7,828.19
|
| Rate for Payer: First Health Commercial |
$8,288.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,288.68
|
| Rate for Payer: GEHA Commercial |
$6,446.75
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,288.68
|
| Rate for Payer: Multiplan All |
$8,380.77
|
| Rate for Payer: OMNI Networks Commercial |
$6,446.75
|
| Rate for Payer: One Health Plan PPO/POS |
$8,288.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,749.16
|
| Rate for Payer: Three Rivers Provider Network All |
$6,907.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,564.97
|
| Rate for Payer: Zelis Auto |
$3,683.86
|
|
|
IMPLT ALLOGRAFT PATELLA TENDON
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,587.20 |
| Max. Negotiated Rate |
$8,519.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,174.40
|
| Rate for Payer: Cash Price |
$5,380.80
|
| Rate for Payer: Cash Price |
$5,380.80
|
| Rate for Payer: Cigna Commercial |
$7,622.80
|
| Rate for Payer: First Health Commercial |
$8,071.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,071.20
|
| Rate for Payer: GEHA Commercial |
$6,277.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,071.20
|
| Rate for Payer: Multiplan All |
$8,160.88
|
| Rate for Payer: OMNI Networks Commercial |
$6,277.60
|
| Rate for Payer: One Health Plan PPO/POS |
$8,071.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,519.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6,726.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,340.24
|
| Rate for Payer: Zelis Auto |
$3,587.20
|
|
