|
IMPLT AUGMENT FEMORAL DISTAL SIZE 3 15MM
|
Facility
|
IP
|
$3,909.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002647
|
|
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 SIZE 3 15MM
|
Facility
|
OP
|
$3,909.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002647
|
|
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 SIZE 5
|
Facility
|
OP
|
$3,732.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.00 |
| Max. Negotiated Rate |
$3,545.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,239.20
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cigna Commercial |
$3,172.20
|
| Rate for Payer: First Health Commercial |
$3,358.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,358.80
|
| Rate for Payer: GEHA Commercial |
$2,985.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,358.80
|
| Rate for Payer: Humana ChoiceCare |
$970.32
|
| Rate for Payer: Multiplan All |
$3,396.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,239.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,612.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,358.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,545.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,799.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,284.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$933.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,470.76
|
| Rate for Payer: Zelis Auto |
$1,492.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,866.00
|
|
|
IMPLT AUGMENT FEMORAL DISTAL SIZE 5
|
Facility
|
IP
|
$3,732.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.80 |
| Max. Negotiated Rate |
$3,545.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,985.60
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cash Price |
$2,239.20
|
| Rate for Payer: Cigna Commercial |
$3,172.20
|
| Rate for Payer: First Health Commercial |
$3,358.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,358.80
|
| Rate for Payer: GEHA Commercial |
$2,612.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,358.80
|
| Rate for Payer: Multiplan All |
$3,396.12
|
| Rate for Payer: OMNI Networks Commercial |
$2,612.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,358.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,545.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,799.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,470.76
|
| Rate for Payer: Zelis Auto |
$1,492.80
|
|
|
IMPLT AUGMENT FEMORAL POSTERIOR #5
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001882
|
|
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 POSTERIOR #5
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001882
|
|
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 POSTERIOR #6
|
Facility
|
IP
|
$3,762.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001885
|
|
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 POSTERIOR #6
|
Facility
|
OP
|
$3,762.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001885
|
|
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 POSTERIOR SZ 4 5MM
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003192
|
|
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 POSTERIOR SZ 4 5MM
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003192
|
|
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 SZ6 10MM
|
Facility
|
IP
|
$3,762.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001793
|
|
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 SZ6 10MM
|
Facility
|
OP
|
$3,762.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001793
|
|
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 POSTERIOR 10X70MM
|
Facility
|
IP
|
$4,604.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,841.60 |
| Max. Negotiated Rate |
$4,373.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,683.20
|
| Rate for Payer: Cash Price |
$2,762.40
|
| Rate for Payer: Cash Price |
$2,762.40
|
| Rate for Payer: Cigna Commercial |
$3,913.40
|
| Rate for Payer: First Health Commercial |
$4,143.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,143.60
|
| Rate for Payer: GEHA Commercial |
$3,222.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,143.60
|
| Rate for Payer: Multiplan All |
$4,189.64
|
| Rate for Payer: OMNI Networks Commercial |
$3,222.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,143.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,373.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,453.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,281.72
|
| Rate for Payer: Zelis Auto |
$1,841.60
|
|
|
IMPLT AUGMENT POSTERIOR 10X70MM
|
Facility
|
OP
|
$4,604.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.00 |
| Max. Negotiated Rate |
$4,373.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,762.40
|
| Rate for Payer: Cash Price |
$2,762.40
|
| Rate for Payer: Cash Price |
$2,762.40
|
| Rate for Payer: Cigna Commercial |
$3,913.40
|
| Rate for Payer: First Health Commercial |
$4,143.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,143.60
|
| Rate for Payer: GEHA Commercial |
$3,683.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,143.60
|
| Rate for Payer: Humana ChoiceCare |
$1,197.04
|
| Rate for Payer: Multiplan All |
$4,189.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,762.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,222.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,143.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,373.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,453.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,051.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,151.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,281.72
|
| Rate for Payer: Zelis Auto |
$1,841.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,302.00
|
|
|
IMPLT AUGMENT POSTERIOR 10X70MM
|
Facility
|
OP
|
$4,604.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.00 |
| Max. Negotiated Rate |
$4,373.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,762.40
|
| Rate for Payer: Cash Price |
$2,762.40
|
| Rate for Payer: Cash Price |
$2,762.40
|
| Rate for Payer: Cigna Commercial |
$3,913.40
|
| Rate for Payer: First Health Commercial |
$4,143.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,143.60
|
| Rate for Payer: GEHA Commercial |
$3,683.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,143.60
|
| Rate for Payer: Humana ChoiceCare |
$1,197.04
|
| Rate for Payer: Multiplan All |
$4,189.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,762.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,222.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,143.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,373.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,453.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,051.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,151.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,281.72
|
| Rate for Payer: Zelis Auto |
$1,841.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,302.00
|
|
|
IMPLT AUGMENT POSTERIOR 10X70MM
|
Facility
|
IP
|
$4,604.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,841.60 |
| Max. Negotiated Rate |
$4,373.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,683.20
|
| Rate for Payer: Cash Price |
$2,762.40
|
| Rate for Payer: Cash Price |
$2,762.40
|
| Rate for Payer: Cigna Commercial |
$3,913.40
|
| Rate for Payer: First Health Commercial |
$4,143.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,143.60
|
| Rate for Payer: GEHA Commercial |
$3,222.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,143.60
|
| Rate for Payer: Multiplan All |
$4,189.64
|
| Rate for Payer: OMNI Networks Commercial |
$3,222.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,143.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,373.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,453.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,281.72
|
| Rate for Payer: Zelis Auto |
$1,841.60
|
|
|
IMPLT AUGMENT POSTERIOR FEMORAL #4 10MM
|
Facility
|
IP
|
$3,718.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,487.20 |
| Max. Negotiated Rate |
$3,532.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,974.40
|
| Rate for Payer: Cash Price |
$2,230.80
|
| Rate for Payer: Cash Price |
$2,230.80
|
| Rate for Payer: Cigna Commercial |
$3,160.30
|
| Rate for Payer: First Health Commercial |
$3,346.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,346.20
|
| Rate for Payer: GEHA Commercial |
$2,602.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,346.20
|
| Rate for Payer: Multiplan All |
$3,383.38
|
| Rate for Payer: OMNI Networks Commercial |
$2,602.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,346.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,532.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,788.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,457.74
|
| Rate for Payer: Zelis Auto |
$1,487.20
|
|
|
IMPLT AUGMENT POSTERIOR FEMORAL #4 10MM
|
Facility
|
OP
|
$3,718.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.50 |
| Max. Negotiated Rate |
$3,532.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,230.80
|
| Rate for Payer: Cash Price |
$2,230.80
|
| Rate for Payer: Cash Price |
$2,230.80
|
| Rate for Payer: Cigna Commercial |
$3,160.30
|
| Rate for Payer: First Health Commercial |
$3,346.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,346.20
|
| Rate for Payer: GEHA Commercial |
$2,974.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,346.20
|
| Rate for Payer: Humana ChoiceCare |
$966.68
|
| Rate for Payer: Multiplan All |
$3,383.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,230.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,602.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,346.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,532.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,788.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,271.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$929.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,457.74
|
| Rate for Payer: Zelis Auto |
$1,487.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,859.00
|
|
|
IMPLT AUGMENT POSTERIOR FEMORAL #5
|
Facility
|
IP
|
$3,718.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,487.20 |
| Max. Negotiated Rate |
$3,532.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,974.40
|
| Rate for Payer: Cash Price |
$2,230.80
|
| Rate for Payer: Cash Price |
$2,230.80
|
| Rate for Payer: Cigna Commercial |
$3,160.30
|
| Rate for Payer: First Health Commercial |
$3,346.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,346.20
|
| Rate for Payer: GEHA Commercial |
$2,602.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,346.20
|
| Rate for Payer: Multiplan All |
$3,383.38
|
| Rate for Payer: OMNI Networks Commercial |
$2,602.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,346.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,532.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,788.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,457.74
|
| Rate for Payer: Zelis Auto |
$1,487.20
|
|
|
IMPLT AUGMENT POSTERIOR FEMORAL #5
|
Facility
|
OP
|
$3,718.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.50 |
| Max. Negotiated Rate |
$3,532.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,230.80
|
| Rate for Payer: Cash Price |
$2,230.80
|
| Rate for Payer: Cash Price |
$2,230.80
|
| Rate for Payer: Cigna Commercial |
$3,160.30
|
| Rate for Payer: First Health Commercial |
$3,346.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,346.20
|
| Rate for Payer: GEHA Commercial |
$2,974.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,346.20
|
| Rate for Payer: Humana ChoiceCare |
$966.68
|
| Rate for Payer: Multiplan All |
$3,383.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,230.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,602.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,346.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,532.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,788.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,271.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$929.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,457.74
|
| Rate for Payer: Zelis Auto |
$1,487.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,859.00
|
|
|
IMPLT AUGMENT POSTERIOR FEMORAL SIZE 3
|
Facility
|
OP
|
$3,762.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001883
|
|
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 POSTERIOR FEMORAL SIZE 3
|
Facility
|
IP
|
$3,762.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001883
|
|
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 POSTERIOR FEMORAL SIZE 5
|
Facility
|
IP
|
$3,769.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,507.60 |
| Max. Negotiated Rate |
$3,580.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,015.20
|
| Rate for Payer: Cash Price |
$2,261.40
|
| Rate for Payer: Cash Price |
$2,261.40
|
| Rate for Payer: Cigna Commercial |
$3,203.65
|
| Rate for Payer: First Health Commercial |
$3,392.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,392.10
|
| Rate for Payer: GEHA Commercial |
$2,638.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,392.10
|
| Rate for Payer: Multiplan All |
$3,429.79
|
| Rate for Payer: OMNI Networks Commercial |
$2,638.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,392.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,580.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,826.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,505.17
|
| Rate for Payer: Zelis Auto |
$1,507.60
|
|
|
IMPLT AUGMENT POSTERIOR FEMORAL SIZE 5
|
Facility
|
OP
|
$3,769.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.25 |
| Max. Negotiated Rate |
$3,580.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,261.40
|
| Rate for Payer: Cash Price |
$2,261.40
|
| Rate for Payer: Cash Price |
$2,261.40
|
| Rate for Payer: Cigna Commercial |
$3,203.65
|
| Rate for Payer: First Health Commercial |
$3,392.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,392.10
|
| Rate for Payer: GEHA Commercial |
$3,015.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,392.10
|
| Rate for Payer: Humana ChoiceCare |
$979.94
|
| Rate for Payer: Multiplan All |
$3,429.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,261.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,638.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,392.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,580.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,826.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,316.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$942.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,505.17
|
| Rate for Payer: Zelis Auto |
$1,507.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,884.50
|
|
|
IMPLT AUGMENT POSTERIOR FEMORAL SIZE 7
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002640
|
|
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
|
|
