|
IMPLT AUGMENT FEMORAL DISTAL #2 RIGHT
|
Facility
|
OP
|
$4,682.16
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,170.54 |
| Max. Negotiated Rate |
$4,448.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,809.30
|
| Rate for Payer: Cash Price |
$2,809.30
|
| Rate for Payer: Cash Price |
$2,809.30
|
| Rate for Payer: Cigna Commercial |
$3,979.84
|
| Rate for Payer: First Health Commercial |
$4,213.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,213.94
|
| Rate for Payer: GEHA Commercial |
$3,745.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,213.94
|
| Rate for Payer: Humana ChoiceCare |
$1,217.36
|
| Rate for Payer: Multiplan All |
$4,260.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,809.30
|
| Rate for Payer: OMNI Networks Commercial |
$3,277.51
|
| Rate for Payer: One Health Plan PPO/POS |
$4,213.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,448.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,511.62
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,120.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,170.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,354.41
|
| Rate for Payer: Zelis Auto |
$1,872.86
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,341.08
|
|
|
IMPLT AUGMENT FEMORAL DISTAL #3 10MM LFT
|
Facility
|
IP
|
$3,762.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,504.80 |
| Max. Negotiated Rate |
$3,573.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,009.60
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cigna Commercial |
$3,197.70
|
| Rate for Payer: First Health Commercial |
$3,385.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,385.80
|
| Rate for Payer: GEHA Commercial |
$2,633.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,385.80
|
| Rate for Payer: Multiplan All |
$3,423.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,633.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,385.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,573.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,821.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,498.66
|
| Rate for Payer: Zelis Auto |
$1,504.80
|
|
|
IMPLT AUGMENT FEMORAL DISTAL #3 10MM LFT
|
Facility
|
OP
|
$3,762.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$940.50 |
| Max. Negotiated Rate |
$3,573.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,257.20
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cigna Commercial |
$3,197.70
|
| Rate for Payer: First Health Commercial |
$3,385.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,385.80
|
| Rate for Payer: GEHA Commercial |
$3,009.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,385.80
|
| Rate for Payer: Humana ChoiceCare |
$978.12
|
| Rate for Payer: Multiplan All |
$3,423.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,257.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,633.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,385.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,573.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,821.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,310.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$940.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,498.66
|
| Rate for Payer: Zelis Auto |
$1,504.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,881.00
|
|
|
IMPLT AUGMENT FEMORAL DISTAL #3 15MM LFT
|
Facility
|
IP
|
$3,909.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.60 |
| Max. Negotiated Rate |
$3,713.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,127.20
|
| Rate for Payer: Cash Price |
$2,345.40
|
| Rate for Payer: Cash Price |
$2,345.40
|
| Rate for Payer: Cigna Commercial |
$3,322.65
|
| Rate for Payer: First Health Commercial |
$3,518.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,518.10
|
| Rate for Payer: GEHA Commercial |
$2,736.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,518.10
|
| Rate for Payer: Multiplan All |
$3,557.19
|
| Rate for Payer: OMNI Networks Commercial |
$2,736.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,518.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,713.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,931.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,635.37
|
| Rate for Payer: Zelis Auto |
$1,563.60
|
|
|
IMPLT AUGMENT FEMORAL DISTAL #3 15MM LFT
|
Facility
|
OP
|
$3,909.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$977.25 |
| Max. Negotiated Rate |
$3,713.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,345.40
|
| Rate for Payer: Cash Price |
$2,345.40
|
| Rate for Payer: Cash Price |
$2,345.40
|
| Rate for Payer: Cigna Commercial |
$3,322.65
|
| Rate for Payer: First Health Commercial |
$3,518.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,518.10
|
| Rate for Payer: GEHA Commercial |
$3,127.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,518.10
|
| Rate for Payer: Humana ChoiceCare |
$1,016.34
|
| Rate for Payer: Multiplan All |
$3,557.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,345.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,736.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,518.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,713.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,931.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,439.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$977.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,635.37
|
| Rate for Payer: Zelis Auto |
$1,563.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,954.50
|
|
|
IMPLT AUGMENT FEMORAL DISTAL #4 10MM RGT
|
Facility
|
OP
|
$4,092.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7008047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,887.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,455.20
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cigna Commercial |
$3,478.20
|
| Rate for Payer: First Health Commercial |
$3,682.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,682.80
|
| Rate for Payer: GEHA Commercial |
$3,273.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,682.80
|
| Rate for Payer: Humana ChoiceCare |
$1,063.92
|
| Rate for Payer: Multiplan All |
$3,723.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,455.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,864.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,682.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,887.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,069.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,600.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,023.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,805.56
|
| Rate for Payer: Zelis Auto |
$1,636.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,046.00
|
|
|
IMPLT AUGMENT FEMORAL DISTAL #4 10MM RGT
|
Facility
|
IP
|
$4,092.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7008047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,636.80 |
| Max. Negotiated Rate |
$3,887.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,273.60
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cigna Commercial |
$3,478.20
|
| Rate for Payer: First Health Commercial |
$3,682.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,682.80
|
| Rate for Payer: GEHA Commercial |
$2,864.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,682.80
|
| Rate for Payer: Multiplan All |
$3,723.72
|
| Rate for Payer: OMNI Networks Commercial |
$2,864.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,682.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,887.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,069.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,805.56
|
| Rate for Payer: Zelis Auto |
$1,636.80
|
|
|
IMPLT AUGMENT FEMORAL DISTAL #4 10MM RGT
|
Facility
|
IP
|
$4,092.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,636.80 |
| Max. Negotiated Rate |
$3,887.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,273.60
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cigna Commercial |
$3,478.20
|
| Rate for Payer: First Health Commercial |
$3,682.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,682.80
|
| Rate for Payer: GEHA Commercial |
$2,864.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,682.80
|
| Rate for Payer: Multiplan All |
$3,723.72
|
| Rate for Payer: OMNI Networks Commercial |
$2,864.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,682.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,887.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,069.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,805.56
|
| Rate for Payer: Zelis Auto |
$1,636.80
|
|
|
IMPLT AUGMENT FEMORAL DISTAL #4 10MM RGT
|
Facility
|
OP
|
$4,092.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,887.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,455.20
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cigna Commercial |
$3,478.20
|
| Rate for Payer: First Health Commercial |
$3,682.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,682.80
|
| Rate for Payer: GEHA Commercial |
$3,273.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,682.80
|
| Rate for Payer: Humana ChoiceCare |
$1,063.92
|
| Rate for Payer: Multiplan All |
$3,723.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,455.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,864.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,682.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,887.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,069.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,600.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,023.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,805.56
|
| Rate for Payer: Zelis Auto |
$1,636.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,046.00
|
|
|
IMPLT AUGMENT FEMORAL DISTAL 4 SIZE
|
Facility
|
IP
|
$3,916.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,566.40 |
| Max. Negotiated Rate |
$3,720.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,132.80
|
| Rate for Payer: Cash Price |
$2,349.60
|
| Rate for Payer: Cash Price |
$2,349.60
|
| Rate for Payer: Cigna Commercial |
$3,328.60
|
| Rate for Payer: First Health Commercial |
$3,524.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,524.40
|
| Rate for Payer: GEHA Commercial |
$2,741.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,524.40
|
| Rate for Payer: Multiplan All |
$3,563.56
|
| Rate for Payer: OMNI Networks Commercial |
$2,741.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,524.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,720.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,937.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,641.88
|
| Rate for Payer: Zelis Auto |
$1,566.40
|
|
|
IMPLT AUGMENT FEMORAL DISTAL 4 SIZE
|
Facility
|
OP
|
$3,916.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.00 |
| Max. Negotiated Rate |
$3,720.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,349.60
|
| Rate for Payer: Cash Price |
$2,349.60
|
| Rate for Payer: Cash Price |
$2,349.60
|
| Rate for Payer: Cigna Commercial |
$3,328.60
|
| Rate for Payer: First Health Commercial |
$3,524.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,524.40
|
| Rate for Payer: GEHA Commercial |
$3,132.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,524.40
|
| Rate for Payer: Humana ChoiceCare |
$1,018.16
|
| Rate for Payer: Multiplan All |
$3,563.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,349.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,741.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,524.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,720.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,937.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,446.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$979.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,641.88
|
| Rate for Payer: Zelis Auto |
$1,566.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,958.00
|
|
|
IMPLT AUGMENT FEMORAL DISTAL #5
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,553.20 |
| Max. Negotiated Rate |
$3,688.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,106.40
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cigna Commercial |
$3,300.55
|
| Rate for Payer: First Health Commercial |
$3,494.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,494.70
|
| Rate for Payer: GEHA Commercial |
$2,718.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,494.70
|
| Rate for Payer: Multiplan All |
$3,533.53
|
| Rate for Payer: OMNI Networks Commercial |
$2,718.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,494.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,688.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,912.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,611.19
|
| Rate for Payer: Zelis Auto |
$1,553.20
|
|
|
IMPLT AUGMENT FEMORAL DISTAL #5
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.75 |
| Max. Negotiated Rate |
$3,688.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,329.80
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cigna Commercial |
$3,300.55
|
| Rate for Payer: First Health Commercial |
$3,494.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,494.70
|
| Rate for Payer: GEHA Commercial |
$3,106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,494.70
|
| Rate for Payer: Humana ChoiceCare |
$1,009.58
|
| Rate for Payer: Multiplan All |
$3,533.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,329.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,718.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,494.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,688.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,912.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,417.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$970.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,611.19
|
| Rate for Payer: Zelis Auto |
$1,553.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,941.50
|
|
|
IMPLT AUGMENT FEMORAL DISTAL LEFT 10MM
|
Facility
|
IP
|
$3,762.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,504.80 |
| Max. Negotiated Rate |
$3,573.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,009.60
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cigna Commercial |
$3,197.70
|
| Rate for Payer: First Health Commercial |
$3,385.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,385.80
|
| Rate for Payer: GEHA Commercial |
$2,633.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,385.80
|
| Rate for Payer: Multiplan All |
$3,423.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,633.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,385.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,573.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,821.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,498.66
|
| Rate for Payer: Zelis Auto |
$1,504.80
|
|
|
IMPLT AUGMENT FEMORAL DISTAL LEFT 10MM
|
Facility
|
OP
|
$3,762.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$940.50 |
| Max. Negotiated Rate |
$3,573.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,257.20
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cigna Commercial |
$3,197.70
|
| Rate for Payer: First Health Commercial |
$3,385.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,385.80
|
| Rate for Payer: GEHA Commercial |
$3,009.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,385.80
|
| Rate for Payer: Humana ChoiceCare |
$978.12
|
| Rate for Payer: Multiplan All |
$3,423.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,257.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,633.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,385.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,573.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,821.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,310.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$940.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,498.66
|
| Rate for Payer: Zelis Auto |
$1,504.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,881.00
|
|
|
IMPLT AUGMENT FEMORAL DISTAL LEFT SZ 4
|
Facility
|
OP
|
$4,035.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.75 |
| Max. Negotiated Rate |
$3,833.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,421.00
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Cigna Commercial |
$3,429.75
|
| Rate for Payer: First Health Commercial |
$3,631.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,631.50
|
| Rate for Payer: GEHA Commercial |
$3,228.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,631.50
|
| Rate for Payer: Humana ChoiceCare |
$1,049.10
|
| Rate for Payer: Multiplan All |
$3,671.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,421.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,824.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,631.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,833.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,026.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,550.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,008.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,752.55
|
| Rate for Payer: Zelis Auto |
$1,614.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,017.50
|
|
|
IMPLT AUGMENT FEMORAL DISTAL LEFT SZ 4
|
Facility
|
IP
|
$4,035.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,614.00 |
| Max. Negotiated Rate |
$3,833.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,228.00
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Cigna Commercial |
$3,429.75
|
| Rate for Payer: First Health Commercial |
$3,631.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,631.50
|
| Rate for Payer: GEHA Commercial |
$2,824.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,631.50
|
| Rate for Payer: Multiplan All |
$3,671.85
|
| Rate for Payer: OMNI Networks Commercial |
$2,824.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,631.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,833.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,026.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,752.55
|
| Rate for Payer: Zelis Auto |
$1,614.00
|
|
|
IMPLT AUGMENT FEMORAL DISTAL LFT SIZE#3
|
Facility
|
IP
|
$3,618.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.20 |
| Max. Negotiated Rate |
$3,437.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,894.40
|
| Rate for Payer: Cash Price |
$2,170.80
|
| Rate for Payer: Cash Price |
$2,170.80
|
| Rate for Payer: Cigna Commercial |
$3,075.30
|
| Rate for Payer: First Health Commercial |
$3,256.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,256.20
|
| Rate for Payer: GEHA Commercial |
$2,532.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,256.20
|
| Rate for Payer: Multiplan All |
$3,292.38
|
| Rate for Payer: OMNI Networks Commercial |
$2,532.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,256.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,437.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,713.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,364.74
|
| Rate for Payer: Zelis Auto |
$1,447.20
|
|
|
IMPLT AUGMENT FEMORAL DISTAL LFT SIZE#3
|
Facility
|
OP
|
$3,618.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.50 |
| Max. Negotiated Rate |
$3,437.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,170.80
|
| Rate for Payer: Cash Price |
$2,170.80
|
| Rate for Payer: Cash Price |
$2,170.80
|
| Rate for Payer: Cigna Commercial |
$3,075.30
|
| Rate for Payer: First Health Commercial |
$3,256.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,256.20
|
| Rate for Payer: GEHA Commercial |
$2,894.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,256.20
|
| Rate for Payer: Humana ChoiceCare |
$940.68
|
| Rate for Payer: Multiplan All |
$3,292.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,170.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,532.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,256.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,437.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,713.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,183.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$904.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,364.74
|
| Rate for Payer: Zelis Auto |
$1,447.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,809.00
|
|
|
IMPLT AUGMENT FEMORAL DISTAL RIGHT 10MM
|
Facility
|
OP
|
$3,762.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$940.50 |
| Max. Negotiated Rate |
$3,573.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,257.20
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cigna Commercial |
$3,197.70
|
| Rate for Payer: First Health Commercial |
$3,385.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,385.80
|
| Rate for Payer: GEHA Commercial |
$3,009.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,385.80
|
| Rate for Payer: Humana ChoiceCare |
$978.12
|
| Rate for Payer: Multiplan All |
$3,423.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,257.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,633.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,385.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,573.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,821.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,310.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$940.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,498.66
|
| Rate for Payer: Zelis Auto |
$1,504.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,881.00
|
|
|
IMPLT AUGMENT FEMORAL DISTAL RIGHT 10MM
|
Facility
|
IP
|
$3,762.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,504.80 |
| Max. Negotiated Rate |
$3,573.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,009.60
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cigna Commercial |
$3,197.70
|
| Rate for Payer: First Health Commercial |
$3,385.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,385.80
|
| Rate for Payer: GEHA Commercial |
$2,633.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,385.80
|
| Rate for Payer: Multiplan All |
$3,423.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,633.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,385.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,573.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,821.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,498.66
|
| Rate for Payer: Zelis Auto |
$1,504.80
|
|
|
IMPLT AUGMENT FEMORAL DISTAL RIGHT 15MM
|
Facility
|
OP
|
$3,863.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.75 |
| Max. Negotiated Rate |
$3,669.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,317.80
|
| Rate for Payer: Cash Price |
$2,317.80
|
| Rate for Payer: Cash Price |
$2,317.80
|
| Rate for Payer: Cigna Commercial |
$3,283.55
|
| Rate for Payer: First Health Commercial |
$3,476.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,476.70
|
| Rate for Payer: GEHA Commercial |
$3,090.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,476.70
|
| Rate for Payer: Humana ChoiceCare |
$1,004.38
|
| Rate for Payer: Multiplan All |
$3,515.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,317.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,704.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,476.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,669.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,897.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,399.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$965.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,592.59
|
| Rate for Payer: Zelis Auto |
$1,545.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,931.50
|
|
|
IMPLT AUGMENT FEMORAL DISTAL RIGHT 15MM
|
Facility
|
IP
|
$3,863.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.20 |
| Max. Negotiated Rate |
$3,669.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,090.40
|
| Rate for Payer: Cash Price |
$2,317.80
|
| Rate for Payer: Cash Price |
$2,317.80
|
| Rate for Payer: Cigna Commercial |
$3,283.55
|
| Rate for Payer: First Health Commercial |
$3,476.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,476.70
|
| Rate for Payer: GEHA Commercial |
$2,704.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,476.70
|
| Rate for Payer: Multiplan All |
$3,515.33
|
| Rate for Payer: OMNI Networks Commercial |
$2,704.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,476.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,669.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,897.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,592.59
|
| Rate for Payer: Zelis Auto |
$1,545.20
|
|
|
IMPLT AUGMENT FEMORAL DISTAL SIZE 3
|
Facility
|
OP
|
$6,701.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.25 |
| Max. Negotiated Rate |
$6,365.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,020.60
|
| Rate for Payer: Cash Price |
$4,020.60
|
| Rate for Payer: Cash Price |
$4,020.60
|
| Rate for Payer: Cigna Commercial |
$5,695.85
|
| Rate for Payer: First Health Commercial |
$6,030.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,030.90
|
| Rate for Payer: GEHA Commercial |
$5,360.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,030.90
|
| Rate for Payer: Humana ChoiceCare |
$1,742.26
|
| Rate for Payer: Multiplan All |
$6,097.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,020.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,690.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,030.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,365.95
|
| Rate for Payer: Three Rivers Provider Network All |
$5,025.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,896.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,675.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,231.93
|
| Rate for Payer: Zelis Auto |
$2,680.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,350.50
|
|
|
IMPLT AUGMENT FEMORAL DISTAL SIZE 3
|
Facility
|
IP
|
$6,701.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.40 |
| Max. Negotiated Rate |
$6,365.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,360.80
|
| Rate for Payer: Cash Price |
$4,020.60
|
| Rate for Payer: Cash Price |
$4,020.60
|
| Rate for Payer: Cigna Commercial |
$5,695.85
|
| Rate for Payer: First Health Commercial |
$6,030.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,030.90
|
| Rate for Payer: GEHA Commercial |
$4,690.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,030.90
|
| Rate for Payer: Multiplan All |
$6,097.91
|
| Rate for Payer: OMNI Networks Commercial |
$4,690.70
|
| Rate for Payer: One Health Plan PPO/POS |
$6,030.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,365.95
|
| Rate for Payer: Three Rivers Provider Network All |
$5,025.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,231.93
|
| Rate for Payer: Zelis Auto |
$2,680.40
|
|
